Department of Interventional Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
Department of Echocardiography, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
Arch Cardiol Mex. 2020;90(2):108-115. doi: 10.24875/ACME.M20000103.
Paravalvular leak (PVL) is a frequent and important complication after surgical valvular replacement that can cause heart failure and hemolytic anemia and is associated with poor clinical outcomes. Surgical reoperation has been the standard treatment, but it is associated with high morbidity and mortality. Transcatheter closure is a therapeutic alternative. The aim of the present study is to analyze the feasibility and the short- and medium-term outcomes of the transcatheter closure of PVLs.
Single-center registry of consecutive patients with post-surgical PVLs that underwent transcatheter closure, between January 2006 and December 2016. Efficacy and safety results were analyzed during the procedure and at 6-month follow-up.
Twenty-one PVLs (15 mitral, 5 aortic, and 1 tricuspid) were closure during 20 procedures. In the initial echocardiography, 91% of the leaks were severe. The most used device was the Amplatzer Vascular Plug III in 10 procedures (50%). The three-dimensional transesophageal echocardiography was used in 70% of cases. The device was successfully implanted in 95% of cases, a regurgitation reduction ≥ 1 grade was achieved in 95% of the cases, and the clinical success was 79%. Six-month survival was 100%; however, three cases required valvular surgery (15%).
Transcatheter closure of PVLs is a feasible and safe procedure with high rates of technical, echocardiographic, and clinical success in the short and medium term. It is an adequate therapeutic alternative, mainly in high surgical risk patients and multiples comorbidities.
外科瓣膜置换术后瓣周漏（PVL）是一种常见且重要的并发症，可导致心力衰竭和溶血性贫血，并与不良临床结局相关。外科再次手术一直是标准治疗方法，但它与高发病率和死亡率相关。经导管封堵是一种治疗选择。本研究旨在分析经导管封堵 PVL 的可行性以及短期和中期结果。
连续回顾 2006 年 1 月至 2016 年 12 月期间接受经导管封堵的外科术后 PVL 患者的单中心登记资料。术中及 6 个月随访时分析疗效和安全性结果。
20 次手术中封堵了 21 个 PVL（15 个二尖瓣、5 个主动脉瓣和 1 个三尖瓣）。初始超声心动图中，91%的漏口为重度。最常使用的装置是 Amplatzer 血管塞 III，在 10 次手术（50%）中使用。70%的病例使用了三维经食管超声心动图。95%的病例成功植入了装置，95%的病例反流减少≥1 级，临床成功率为 79%。6 个月生存率为 100%；然而，有 3 例需要瓣膜手术（15%）。
经导管封堵 PVL 是一种可行且安全的方法，在短期和中期具有较高的技术、超声心动图和临床成功率。它是一种合适的治疗选择，主要适用于高手术风险患者和多种合并症患者。
