Transcatheter Closure of Paravalvular Leaks: Efficacy, Techniques, and Outcomes From a Single-Center Prospective...

Paravalvular leak (PVL) is a complication after prosthetic valve implantation, leading to issues like hemolysis and heart failure. While redo surgery is the standard treatment, it poses significant risks for high-risk patients. Transcatheter PVL closure has become a less invasive option, with improved efficacy from advanced imaging and device technologies.

This study aims to evaluate the safety, efficacy, and technical strategies of transcatheter PVL closure, including novel approaches like the reverse loop and arteriovenous (AV) rail techniques in a prospective single-center cohort.

Twenty-eight high-risk patients (mean age 57.2 ± 10.1 years) with significant aortic or mitral PVLs underwent transcatheter closure. Procedures were guided by multimodal imaging, assessing technical, procedural, and clinical success rates, along with 6-month outcomes in NYHA functional class and echocardiographic parameters.

Out of 28 procedures, 27 were technically successful (96.4%), with clinical success achieved in 92.9% of patients. Most procedures used transfemoral access, treating aortic PVLs retrogradely and mitral PVLs through various routes. Advanced techniques like reverse loop (n = 4) and AV rail (n = 3) were utilized in complex cases. NYHA functional class improved significantly (p < 0.001), with no significant change in left ventricular ejection fraction. One patient required redo surgery, and one died from sepsis.

Transcatheter PVL closure is a safe and effective alternative to redo surgery for selected high-risk patients. Advanced imaging and access techniques enhance procedural success, particularly in complex mitral PVLs. Further multicenter studies with long-term follow-up are needed to confirm these results and refine technique selection.