Treatment of paravalvular leaks through interventional techniques

Paravalvular leaks are a relevant complication after both surgical and interventional valve replacement. Approximately 1-5% of patients undergoing mitral or aortic valve replacement experience some sort of paravalvular leakage with varying clinical importance, ranging from asymptomatic to life-threatening. Repeated surgery has usually been considered the first choice to solve this problem, but this approach carries a high operative risk with mortality rates of up to 16% and an increased risk for re-leaks compared to the initial procedure. Transcatheter closure of paravalvular leaks using occluder devices has first been described in 1992. Since then, this technique slowly evolved with various technical improvements, being now a suitable alternative to redo-surgery in patients at high surgical risk with appropriate defect geometries. Particularly the introduction of specifically designed devices as well as improved imaging tools such as three-dimensional real-time echocardiography facilitate the procedure, likely to play an increasingly important role in the future.