Cardiac Computed Tomography-Guided Procedural Planning for Percutaneous Mitral Paravalvular Leak Closure: Impact on...

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Procedures

Background:

• Mitral paravalvular leaks (PVLs) are a complication of prosthetic valve implantation, potentially causing heart failure or hemolysis.
• Percutaneous closure is an option for high-risk surgical patients, but crossing the PVL is technically challenging.
• Cardiac computed tomography angiography (CCTA) offers potential for improved fluoroscopic projection planning.

Purpose of the Study:

• To evaluate the impact of CCTA-based pre-procedural planning on the efficiency of percutaneous mitral PVL closure.
• To assess the feasibility and effectiveness of CCTA-derived fluoroscopic projections for PVL crossing.

Main Methods:

• Retrospective single-center study of consecutive patients undergoing percutaneous mitral PVL closure with CCTA planning.
• CCTA used for PVL localization and derivation of optimal fluoroscopic projections.
• Comparison of PVL crossing time, fluoroscopy time, radiation dose, and procedural success between CCTA-feasible and non-feasible cases.

Main Results:

• CCTA-derived projections were feasible in 78.9% of 38 mitral PVLs.
• PVL crossing success was 97.4% and device implantation success was 94.7%.
• Median crossing time was significantly shorter with CCTA-feasible projections (10.5 vs. 32.0 minutes; p=0.018). Posterior PVLs had the longest crossing times and highest radiation exposure.

Conclusions:

• CCTA-based pre-procedural planning enhances procedural efficiency in percutaneous mitral PVL closure by reducing PVL crossing time.
• Posterior PVLs present the greatest procedural complexity due to anatomical and mechanical factors.