DASH Closure: A Dual Access Strategy for Hemodynamic Closure of Mitral Paravalvular Leaks

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Paravalvular leaks (PVLs) are frequent complications after prosthetic valve implantation, leading to heart failure and hemolysis.
• Traditional single-access percutaneous closure methods face challenges with complex anatomies and multiple PVLs.

Purpose of the Study:

• To describe a dual-access strategy for percutaneous closure of complex mitral paravalvular leaks.
• To evaluate the feasibility and efficacy of this approach in a patient with multiple PVLs and a mechanical mitral prosthesis.

Main Methods:

• A dual-access strategy was employed, utilizing both anterograde transseptal and retrograde transfemoral arterial approaches.
• Two dedicated PVL occluder devices were successfully implanted in anterior and posterolateral defects.
• Procedural details included total time, fluoroscopy time, and contrast volume.

Main Results:

• Successful implantation of devices without impacting prosthetic leaflet motion.
• No periprocedural complications occurred.
• The patient showed sustained clinical improvement, with resolved hemolysis and trivial residual leak post-procedure.

Conclusions:

• A planned dual-access strategy can be a valuable technical option for selected patients with multiple, complex mitral PVLs.
• This approach facilitates safe device delivery when single-access methods are limited by anatomy or device manipulation.
• Further studies are needed to establish the indications, safety, and durability of the dual-access approach (DASH).