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Transcatheter Paravalvular Leak Closure: A Step-by-Step Guide.

Georgios E Papadopoulos1, Ilias Ninios1, Sotirios Evangelou1

  • 1Cardiology Department, Interbalkan Medical Center, 55535 Thessaloniki, Greece.

Journal of Cardiovascular Development and Disease
|February 26, 2026
PubMed
Summary
This summary is machine-generated.

Transcatheter paravalvular leak (PVL) closure is a vital alternative for high-risk patients. Achieving minimal residual leak and avoiding complications are key to successful outcomes in PVL treatment.

Keywords:
TAVIbailout strategiescardiac computed tomographycardiac magnetic resonancecomplicationsheart failurehemolysisparavalvular leakprosthetic valvetranscatheter closuretransesophageal echocardiography

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Paravalvular leak (PVL) is a significant complication following valve implantation, often leading to heart failure or hemolysis.
  • Transcatheter PVL closure offers a less invasive alternative for patients with high surgical risk.
  • Existing outcome data for transcatheter PVL closure are limited by heterogeneity in study designs and definitions.

Purpose of the Study:

  • To provide a phenotype-driven approach for transcatheter paravalvular leak (PVL) closure.
  • To emphasize the importance of multimodality imaging, tailored planning, and device selection in PVL treatment.
  • To review complications, bailout strategies, and critical safety checks in transcatheter PVL closure.

Main Methods:

  • Review of observational series and registries on transcatheter PVL closure.
  • Emphasis on multimodality imaging including TEE, cardiac CT, CMR, and PET.
  • Phenotype-driven procedural approach focusing on imaging, planning, device selection, and complication management.

Main Results:

  • Procedural success in transcatheter PVL closure is strongly linked to achieving minimal residual leak without complications.
  • Morphology-matched device selection and modular strategies are crucial for complex PVL anatomies.
  • Experienced programs demonstrate high implant success, with clinical improvement tied to procedural quality and Heart Team selection.

Conclusions:

  • Transcatheter PVL closure is effective when performed with meticulous attention to procedural endpoints and patient selection.
  • Standardized frameworks and imaging are essential for harmonized PVL grading and outcome assessment.
  • Careful planning and execution are critical to minimize preventable, high-severity complications.