Percutaneous device closure of paravalvular leak: combined experience from the United Kingdom and Ireland
Paravalvular leak (PVL) occurs in 5% to 17% of patients following surgical valve replacement. Percutaneous device closure represents an alternative to repeat surgery.All UK and Ireland centers undertaking percutaneous PVL closure submitted data to the UK PVL Registry. Data were analyzed for associat...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
American Heart Association
2016
|
| _version_ | 1826299405225951232 |
|---|---|
| author | Calvert, P Northridge, D Malik, I Shapiro, L Ludman, P Qureshi, S Mullen, M Henderson, R Turner, M Been, M Walsh, K Casserly, I Morrison, L Walker, N Thomson, J Spence, M Mahadevan, V Hoye, A MacCarthy, P Daniels, M Clift, P Davies, W Adamson, P Morgan, G Aggarwal, S Ismail, Y Ormerod, J Khan, H Chandran, S de Giovanni, J Rana, B Ormerod, O Hildick-Smith, D |
| author_facet | Calvert, P Northridge, D Malik, I Shapiro, L Ludman, P Qureshi, S Mullen, M Henderson, R Turner, M Been, M Walsh, K Casserly, I Morrison, L Walker, N Thomson, J Spence, M Mahadevan, V Hoye, A MacCarthy, P Daniels, M Clift, P Davies, W Adamson, P Morgan, G Aggarwal, S Ismail, Y Ormerod, J Khan, H Chandran, S de Giovanni, J Rana, B Ormerod, O Hildick-Smith, D |
| author_sort | Calvert, P |
| collection | OXFORD |
| description | Paravalvular leak (PVL) occurs in 5% to 17% of patients following surgical valve replacement. Percutaneous device closure represents an alternative to repeat surgery.All UK and Ireland centers undertaking percutaneous PVL closure submitted data to the UK PVL Registry. Data were analyzed for association with death and major adverse cardiovascular events (MACE) at follow-up.Three hundred eight PVL closure procedures were attempted in 259 patients in 20 centers (2004-2015). Patient age was 67±13 years; 28% were female. The main indications for closure were heart failure (80%) and hemolysis (16%). Devices were successfully implanted in 91% of patients, via radial (7%), femoral arterial (52%), femoral venous (33%), and apical (7%) approaches. Nineteen percent of patients required repeat procedures. The target valve was mitral (44%), aortic (48%), both (2%), pulmonic (0.4%), or transcatheter aortic valve replacement (5%). Preprocedural leak was severe (61%), moderate (34%), or mild (5.7%) and was multiple in 37%. PVL improved postprocedure (P<0.001) and was none (33.3%), mild (41.4%), moderate (18.6%), or severe (6.7%) at last follow-up. Mean New York Heart Association class improved from 2.7±0.8 preprocedure to 1.6±0.8 (P<0.001) after a median follow-up of 110 (7-452) days. Hospital mortality was 2.9% (elective), 6.8% (in-hospital urgent), and 50% (emergency) (P<0.001). MACE during follow-up included death (16%), valve surgery (6%), late device embolization (0.4%), and new hemolysis requiring transfusion (1.6%). Mitral PVL was associated with higher MACE (hazard ratio [HR], 1.83; P=0.011). Factors independently associated with death were the degree of persisting leak (HR, 2.87; P=0.037), New York Heart Association class (HR, 2.00; P=0.015) at follow-up and baseline creatinine (HR, 8.19; P=0.001). The only factor independently associated with MACE was the degree of persisting leak at follow-up (HR, 3.01; P=0.002).Percutaneous closure of PVL is an effective procedure that improves PVL severity and symptoms. Severity of persisting leak at follow-up is independently associated with both MACE and death. Percutaneous closure should be considered as an alternative to repeat surgery. |
| first_indexed | 2024-03-07T05:01:27Z |
| format | Journal article |
| id | oxford-uuid:d8690d6e-b1d1-41e0-8f3d-10d5ccd7b590 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T05:01:27Z |
| publishDate | 2016 |
| publisher | American Heart Association |
| record_format | dspace |
| spelling | oxford-uuid:d8690d6e-b1d1-41e0-8f3d-10d5ccd7b5902022-03-27T08:48:29ZPercutaneous device closure of paravalvular leak: combined experience from the United Kingdom and IrelandJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:d8690d6e-b1d1-41e0-8f3d-10d5ccd7b590EnglishSymplectic Elements at OxfordAmerican Heart Association2016Calvert, PNorthridge, DMalik, IShapiro, LLudman, PQureshi, SMullen, MHenderson, RTurner, MBeen, MWalsh, KCasserly, IMorrison, LWalker, NThomson, JSpence, MMahadevan, VHoye, AMacCarthy, PDaniels, MClift, PDavies, WAdamson, PMorgan, GAggarwal, SIsmail, YOrmerod, JKhan, HChandran, Sde Giovanni, JRana, BOrmerod, OHildick-Smith, DParavalvular leak (PVL) occurs in 5% to 17% of patients following surgical valve replacement. Percutaneous device closure represents an alternative to repeat surgery.All UK and Ireland centers undertaking percutaneous PVL closure submitted data to the UK PVL Registry. Data were analyzed for association with death and major adverse cardiovascular events (MACE) at follow-up.Three hundred eight PVL closure procedures were attempted in 259 patients in 20 centers (2004-2015). Patient age was 67±13 years; 28% were female. The main indications for closure were heart failure (80%) and hemolysis (16%). Devices were successfully implanted in 91% of patients, via radial (7%), femoral arterial (52%), femoral venous (33%), and apical (7%) approaches. Nineteen percent of patients required repeat procedures. The target valve was mitral (44%), aortic (48%), both (2%), pulmonic (0.4%), or transcatheter aortic valve replacement (5%). Preprocedural leak was severe (61%), moderate (34%), or mild (5.7%) and was multiple in 37%. PVL improved postprocedure (P<0.001) and was none (33.3%), mild (41.4%), moderate (18.6%), or severe (6.7%) at last follow-up. Mean New York Heart Association class improved from 2.7±0.8 preprocedure to 1.6±0.8 (P<0.001) after a median follow-up of 110 (7-452) days. Hospital mortality was 2.9% (elective), 6.8% (in-hospital urgent), and 50% (emergency) (P<0.001). MACE during follow-up included death (16%), valve surgery (6%), late device embolization (0.4%), and new hemolysis requiring transfusion (1.6%). Mitral PVL was associated with higher MACE (hazard ratio [HR], 1.83; P=0.011). Factors independently associated with death were the degree of persisting leak (HR, 2.87; P=0.037), New York Heart Association class (HR, 2.00; P=0.015) at follow-up and baseline creatinine (HR, 8.19; P=0.001). The only factor independently associated with MACE was the degree of persisting leak at follow-up (HR, 3.01; P=0.002).Percutaneous closure of PVL is an effective procedure that improves PVL severity and symptoms. Severity of persisting leak at follow-up is independently associated with both MACE and death. Percutaneous closure should be considered as an alternative to repeat surgery. |
| spellingShingle | Calvert, P Northridge, D Malik, I Shapiro, L Ludman, P Qureshi, S Mullen, M Henderson, R Turner, M Been, M Walsh, K Casserly, I Morrison, L Walker, N Thomson, J Spence, M Mahadevan, V Hoye, A MacCarthy, P Daniels, M Clift, P Davies, W Adamson, P Morgan, G Aggarwal, S Ismail, Y Ormerod, J Khan, H Chandran, S de Giovanni, J Rana, B Ormerod, O Hildick-Smith, D Percutaneous device closure of paravalvular leak: combined experience from the United Kingdom and Ireland |
| title | Percutaneous device closure of paravalvular leak: combined experience from the United Kingdom and Ireland |
| title_full | Percutaneous device closure of paravalvular leak: combined experience from the United Kingdom and Ireland |
| title_fullStr | Percutaneous device closure of paravalvular leak: combined experience from the United Kingdom and Ireland |
| title_full_unstemmed | Percutaneous device closure of paravalvular leak: combined experience from the United Kingdom and Ireland |
| title_short | Percutaneous device closure of paravalvular leak: combined experience from the United Kingdom and Ireland |
| title_sort | percutaneous device closure of paravalvular leak combined experience from the united kingdom and ireland |
| work_keys_str_mv | AT calvertp percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT northridged percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT maliki percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT shapirol percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT ludmanp percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT qureshis percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT mullenm percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT hendersonr percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT turnerm percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT beenm percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT walshk percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT casserlyi percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT morrisonl percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT walkern percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT thomsonj percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT spencem percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT mahadevanv percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT hoyea percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT maccarthyp percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT danielsm percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT cliftp percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT daviesw percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT adamsonp percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT morgang percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT aggarwals percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT ismaily percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT ormerodj percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT khanh percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT chandrans percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT degiovannij percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT ranab percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT ormerodo percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland AT hildicksmithd percutaneousdeviceclosureofparavalvularleakcombinedexperiencefromtheunitedkingdomandireland |