Paravalvular leak closure after transcatheter aortic valve replacement with a self-expanding prosthesis

Sameer Gafoor, Jennifer Franke, Kerstin Piayda, Simon Lam, Stefan Bertog, Laura Vaskelyte, Ilona Hofmann, Horst Sievert

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Introduction Paravalvular leak (PVL) after percutaneous transcatheter aortic valve replacement (TAVR) is associated with significant morbidity and mortality. Percutaneous PVL closure has been reported for balloon-expandable valves but not self-expandable valves. Methods We conducted a review of cases at our center where patients who received TAVR with self-expandable valves and went on to develop severe PVL underwent percutaneous closure. Baseline demographic, TAVR procedural, PVL procedural, and follow-up data were collected. Results A total of five patients with severe PVL after TAVR with a self-expanding valve underwent percutaneous PVL closure. Four of five patients had a trial of balloon postdilatation after valve deployment and had significant persistent PVL. In all five patients, PVL went from moderate-severe to mild-moderate PVL. There were no adverse events. Conclusion Percutaneous PVL closure for severe PVL self-expanding valve for TAVR is a safe and efficacious procedure. Procedural technique involves transesophageal guidance, a high approach through the valve struts, deployment of an appropriate size device, and careful monitoring. This method may be part of the algorithm for severe PVL after TAVR.

Original languageEnglish (US)
Pages (from-to)147-154
Number of pages8
JournalCatheterization and Cardiovascular Interventions
Volume84
Issue number1
DOIs
StatePublished - Jul 1 2014

Keywords

  • CoreValve
  • paravalvular leak closure
  • replacement
  • self-expanding
  • transcatheter aortic valve implantation

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