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Update in Paravalvular Leak Closure
Aken Desai1, John C Messenger2, Robert Quaife2
1Division of Cardiovascular Medicine, Department of Medicine, University of Colorado Anschutz School of Medicine, 12401 E. 17th Ave, Leprino Building, Room 511, Mail Stop B132, Aurora, CO, 80045, USA. aken.desai@cuanschutz.edu.
Current Cardiology Reports
|July 16, 2021
Summary
Advanced imaging and new devices are improving paravalvular leak (PVL) management. While percutaneous PVL closure shows promise, more data is needed, especially for novel devices awaiting US approval.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Clinically significant paravalvular leak (PVL) is rare, limiting large-scale studies on management.
- Existing evidence on PVL management strategies is scarce.
Purpose of the Study:
- To review current evidence on managing paravalvular leak (PVL).
- To highlight advancements in imaging guidance and novel techniques for PVL closure.
- To discuss approaches for complex PVL plugging.
Main Methods:
- Integration of recent evidence on imaging guidance (gated cardiac CT, 3D TEE, fluoroscopy fusion).
- Review of novel techniques and approaches for PVL closure.
- Analysis of case reports on complex PVL plugging.
Main Results:
- Advanced imaging, including gated cardiac CT and 3D TEE, enhances pre-procedure planning and intra-procedural guidance.
- A new device (Occlutech PLD) shows high success rates outside the USA.
- Percutaneous PVL closure lacks extensive randomized data, and novel devices face regulatory hurdles in the USA.
Conclusions:
- Gated cardiac CT and 3D TEE-fluoro fusion improve procedural efficiency and accuracy in PVL closure.
- Purpose-built devices may enhance percutaneous PVL closure efficacy, but US approval remains a challenge.
- Further research and randomized trials are needed to validate new PVL management strategies.
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