Amplatzer-Based Transcatheter Paravalvular Leak Closure: A Narrative Review of Device Design, Procedural Strategy,...

Paravalvular leak (PVL) is a clinically important complication of surgical prosthetic valve replacement that may lead to heart failure, hemolytic anemia, and repeat intervention. Transcatheter closure has become an accepted alternative to redo surgery in selected high-risk patients, with Amplatzer devices serving as a widely used platform because of their versatility across irregular and crescentic defects. This narrative review summarizes contemporary evidence on the role of Amplatzer-based devices in PVL closure, with an emphasis on device design, imaging-guided procedural strategies, clinical outcomes, safety, comparison with alternative occlusion systems, and future directions. Available data from registries, cohort studies, and comparative observational series indicate high technical success, meaningful improvement in symptoms and hemolysis-related burden, and acceptable medium-term durability in appropriately selected patients. Outcomes, however, remain strongly influenced by leak morphology, prosthetic valve characteristics, access route, imaging quality, and operator experience. Important limitations of the current evidence include the absence of randomized trials, nonuniform endpoint definitions, heterogeneous imaging protocols, and limited long-term comparative durability data. In contemporary structural heart practice, Amplatzer devices remain a widely used and practical platform for transcatheter PVL repair, particularly in experienced centers managing anatomically complex leaks.