Improved Transseptal Access for Transcatheter Paravalvular Leak Closure Using Steerable Delivery Sheaths: Data From a...

Transcatheter closure of mitral paravalvular leaks (PVLs) can be a lengthy and cumbersome procedure that may not guarantee satisfying results. We used steerable sheaths in order to perform these procedures in a faster and more controllable manner.

FlexCath and Occlutech steerable sheaths were used. After transseptal puncture, the sheath was introduced into the left atrium and positioned co-axially above the PVL channel. A 5 Fr Judkins catheter was used to cross the PVL channel. A distance wire was placed in most cases through the sheath in the left atrium. A delivery set with a closure device was introduced. The device was positioned under echocardiographic and fluoroscopic guidance and deployed. Technical success rate (TSR) and implantation time (IT) were compared with a control group of mitral PVLs closed without a steerable sheath.

TSR was higher for the steerable sheath group (93.5% vs 72.7%; P<.05). There were no adverse events during index hospitalization. Median IT was shorter for cases performed with steerable sheaths vs cases performed without a steerable sheath (28.5 min [range, 15-58 min] vs 64 min [range, 35-180 min], respectively; P<.05).

Steerable sheaths are safe and effective devices that support mitral PVL closure, particularly in cases with challenging PVL locations.