Baghi Mohammadsaleh, Kohansal Erfan, Akbarian Mahsa, Adimi Sara, Bakhshandeh Hooman, Firoozi Ata, Salehi Pegah, Mehdizadeh Kasra, Hesami Hamed, Yousefi Mina, Erami Sajjad, Dehghani Yeganeh, Hosseini Zahra, Shojaeifard Maryam
Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Institute Iran University of Medical Sciences Tehran Iran.
Rajaie Cardiovascular Medical and Research Institute Iran University of Medical Sciences Tehran Iran.
Health Sci Rep. 2024 Aug 23;7(8):e70001. doi: 10.1002/hsr2.70001. eCollection 2024 Aug.
Paravalvular leak (PVL) is a serious complication of prosthetic valve replacement. Both surgical and percutaneous closure techniques are used for PVL closure, but optimal strategies and comparative outcomes are uncertain. This study aimed to compare the efficacy and safety of percutaneous versus surgical PVL closure by analyzing changes in leak severity, functional status, echocardiographic parameters, and clinical outcomes.
A total of 72 patients were included in this retrospective cross-sectional single-center study comparing percutaneous ( = 25) and surgical ( = 47) PVL closure from 2015 to 2022. Demographics, medical history, echocardiograms, laboratory data, complications, and mortality data were extracted from the records. Changes in leak severity, NYHA class, echocardiographic parameters, and clinical outcomes were compared between the percutaneous and surgical groups.
Both percutaneous and surgical PVL closure significantly reduced leak severity and improved NYHA class (both < 0.01), with no difference between the quantity of changes in each group. The 30-day mortality was 4% after percutaneous and 6.4% after surgical closure ( = 0.65). At 90 days, mortality was 24% percutaneous versus 17% surgical ( = 0.48). The length of stay in the hospital and post-procedural decrease in hemoglobin were considerably lower in the percutaneous group. The rate of complication rates was similar between the groups. Echocardiographic changes were also comparable.
Percutaneous and surgical PVL closure had similar efficacy in reducing leaks and improving symptoms, with no significant difference in early outcomes. Both options should be considered viable for PVL repair after heart team evaluation.
瓣周漏（PVL）是人工瓣膜置换术的严重并发症。外科手术和经皮封堵技术均用于PVL封堵，但最佳策略和比较结果尚不确定。本研究旨在通过分析漏血严重程度、功能状态、超声心动图参数和临床结局的变化，比较经皮与外科PVL封堵的疗效和安全性。
本项回顾性横断面单中心研究纳入了2015年至2022年期间比较经皮（n = 25）和外科（n = 47）PVL封堵的72例患者。从记录中提取人口统计学、病史、超声心动图、实验室数据、并发症和死亡率数据。比较经皮组和外科组之间漏血严重程度、纽约心脏协会（NYHA）心功能分级、超声心动图参数和临床结局的变化。
经皮和外科PVL封堵均显著降低了漏血严重程度并改善了NYHA心功能分级（均P < 0.01），每组变化量之间无差异。经皮封堵术后30天死亡率为4%，外科封堵术后为6.4%（P = 0.65）。90天时，经皮封堵死亡率为24%，外科封堵为17%（P = 0.48）。经皮组的住院时间和术后血红蛋白下降幅度明显更低。两组之间的并发症发生率相似。超声心动图变化也具有可比性。
经皮和外科PVL封堵在减少漏血和改善症状方面具有相似的疗效，早期结局无显著差异。在心脏团队评估后，两种选择对于PVL修复均应被视为可行。
