Surgery Versus Transcatheter Interventions for Significant Paravalvular Prosthetic Leaks

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Background:

• Paravalvular leak (PVL) is a common complication following prosthetic valve replacement.
• Transcatheter reduction (TR) of PVL offers a less invasive alternative to repeat surgery, with reported lower mortality.

Purpose of the Study:

• To compare the long-term outcomes of surgical correction (SC) versus transcatheter reduction (TR) for significant paravalvular leak (PVL) refractory to medical therapy.
• To evaluate the impact of SC and TR on all-cause death and heart failure hospitalizations.

Main Methods:

• A retrospective study of 231 patients undergoing SC (n=151) or TR (n=80) for PVL between 1994 and 2014.
• Propensity matching and Cox regression models were used to compare long-term outcomes.
• Survival was also compared to matched general and first-time surgical valve replacement populations.

Main Results:

• Over a median follow-up of 3.5 years, SC significantly reduced all-cause death or heart failure hospitalization compared to TR (HR: 0.28; p < 0.001).
• A trend towards reduced all-cause death was observed with SC versus TR (HR: 0.61; p = 0.06).
• Neither SC nor TR normalized survival compared to the general population or patients undergoing their first surgical valve replacement.

Conclusions:

• Surgical correction is associated with superior long-term outcomes for significant prosthetic PVL compared to transcatheter intervention.
• Despite better outcomes, SC involves significant perioperative risks.
• Further research is warranted given the increasing use of transcatheter PVL interventions.