Transcatheter Closure or Surgery for Symptomatic Paravalvular Leaks: The Multicenter KISS Registry

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Background:

• Symptomatic paravalvular leak (PVL) treatment options, transcatheter closure (TC) and surgery, lack a clear optimal strategy.
• Large-scale retrospective studies are needed to compare long-term outcomes between TC and surgical reoperation for PVL.

Purpose of the Study:

• To retrospectively evaluate and compare the long-term outcomes of transcatheter closure (TC) versus surgical reoperation for symptomatic paravalvular leaks (PVLs).
• To assess differences in in-hospital and long-term mortality rates between TC and surgical treatment for PVLs.

Main Methods:

• A retrospective analysis of 335 patients treated for PVL at three tertiary centers between 2002 and 2021.
• Patients were divided into two groups: transcatheter closure (TC) (n=171) and surgical reoperation (n=164).
• Inverse probability weighting was used to adjust for treatment selection bias in regression models. Primary endpoint was all-cause death.

Main Results:

• Technical and procedural success rates were similar between TC and surgery groups.
• The surgery group had significantly higher in-hospital mortality (15.9%) compared to the TC group (4.7%) (adjusted OR, 4.55; P<0.001).
• Long-term mortality rates did not significantly differ between the surgery and TC groups (adjusted HR, 1.11; P=0.679).

Conclusions:

• Percutaneous transcatheter closure of paravalvular leaks is associated with lower early mortality.
• Transcatheter closure demonstrates comparable long-term mortality rates when compared to surgical reoperation for PVL.
• These findings suggest transcatheter closure may be a favorable option for managing symptomatic PVLs.