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Updated: Nov 16, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Transcatheter closure of paravalvular leak: Multicenter experience and follow-up
Konstantinos Kalogeras1, Konstantina Ntalekou2, Konstantina Aggeli2
11(st) Department of Cardiology, University of Athens, 'Hippokration' Hospital, Athens, Greece; 3(rd) Department of Cardiology, University of Athens, 'Sotiria' Hospital, Athens, Greece.
Insights
Percutaneous closure effectively treats paravalvular leaks (PVL) after valve replacement, significantly improving patient heart function and reducing complications. This minimally invasive approach offers high success rates for both aortic and mitral PVL.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Paravalvular leak (PVL) is a frequent complication post-valve replacement, often leading to heart failure and hemolysis.
- Transcatheter PVL closure presents a promising alternative to surgical repair.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous paravalvular leak closure.
- To assess technical and clinical outcomes in a multicenter patient cohort.
Main Methods:
- Retrospective analysis of consecutive patients undergoing percutaneous PVL closure.
- Assessment of procedural characteristics, in-hospital, and long-term clinical outcomes.
- Evaluation of technical success (device deployment) and clinical success (NYHA class/hemolysis improvement).
Main Results:
- 39 patients with aortic (12) or mitral (27) PVL were studied; 45 devices implanted, primarily Amplatzer Vascular Plug III.
- Significant reduction in moderate PVL (87.5% to 10.5%) and improved functional status (NYHA class 2.8 to 1.5).
- High technical success (89.7%) and clinical success (82.1%) rates observed, with no significant difference between aortic and mitral PVL.
Conclusions:
- Percutaneous PVL closure is a safe and effective procedure with high success rates.
- The technique leads to significant PVL reduction and functional status improvement.
- This multicenter experience supports transcatheter closure as a viable treatment option for PVL.
Background:
Paravalvular leak (PVL) is a common complication following valve replacement, which leads to heart failure and hemolysis. Transcatheter PVL closure has emerged as a reliable alternative with promising results. We quote the combined three-center experience of PVL patients treated percutaneously.
Methods:
Consecutive patients treated percutaneously for PVL were retrospectively studied. Procedural characteristics, inhospital, and long-term clinical outcomes were assessed. Technical (successful deployment) and clinical (NYHA and/or hemolysis improvement) success were evaluated.
Results:
In total, 39 patients treated for PVL in either the aortic (12 patients) or the mitral (27 patients) position were studied. Amplatzer Vascular Plug III was the most commonly used device among the 45 devices totally implanted. Postprocedurally, the rates of at least moderate PVL (87.5% preprocedurally vs 10.5% at discharge) and functional status (mean NYHA class 2.8 ± 0.7 on admission vs 1.5 ± 0.8 at follow-up) were statistically significantly improved. Total population technical success rate was 89.7%, being comparable between patients treated for mitral or aortic valve PVLs (92.6% vs 83.3%, respectively). Clinical success was achieved in 82.1% of patient cohort without statistical difference among those with isolated aortic or mitral PVL or among those with PVL closure an indication of heart failure or hemolysis. During a mean follow-up of 33.5 months, five patients died, including one periprocedural death.
Conclusions:
This multicenter recorded experience confirms that percutaneous PVL closure can be performed with high technical and clinical success rates and limited complications that lead to significant PVL reduction and functional status improvement.
