Catheter-based treatment of paravalvular leaks

The incidence of paravalvular leaks after surgical valve replacement is estimated to be 2-17%. Paravalvular leaks (PVL) can be asymptomatic and not require treatment or can cause haemolysis or heart failure. If symptomatic or if the severity of the leak is moderate or severe, redo surgery is a therapeutic option, but this is accompanied by a high perioperative risk and a high recurrence rate. A lower risk alternative is percutaneous PVL closure, with a 1-2% risk of periprocedural death or need for reoperation. These procedures are often intricate, which is reflected by a rather modest rate of procedural success (reported to be around 80%). This requires that better technical solutions become available in the future. Today, only two dedicated devices for PVL closure exist, the AMPLATZER Vascular Plug III and the paravalvular leak device. Besides, many non-dedicated devices are used, such as atrial septal occluders, ventricular septal occluders and a variety of vascular plugs. While aortic PVL are approached with a retrograde transarterial approach, mitral PVL can be approached using either an antegrade transvenous approach (transseptal), a retrograde transapical approach or, rarely, a retrograde transaortic approach.