Abstract 3793: Procedural Characteristics and Short-term Clinical Results of Percutaneous Paraprosthetic Leakage Closure
Background: Paraprosthetic leaks are a complication of cardiac prosthetic valve replacement. These cases are usually derived to surgical repair; however, in some patients even surgical repair is not feasible due to difficult access or high risk procedure. In this setting, patients rejected from surgical repair could be derived to percutaneous closure with the Amplatzer Ductus Occluder (ADO).
Methods: We have analyze the efficacy and safety of percutaneous paraprosthetic leakage closure with ADO in a group of 24 consecutive patients with significant valvular regurgitation as a consequence of paravalvular leak (with symptomatic heart failure or hemolysis) rejected from surgical repair, from February 2003 to April 2006.
Results: We attempted percutaneous paraprosthetic leakage closure with ADO in 24 consecutive patients. 17 (70,8%) were male, an average age of 59,29 years (SD 12,02). The leak was located in the mitral valve in 19 patients (79,2%) and 5 (20,8%) in the aortic valve. Procedure and radioscopy time was 135,6 min (SD 61,5) and 52,7 min (SD 28,64), respectively. Transesophagic ecochardiography guidance during the intervention was done in 15 cases (65,5%). The ADO was successfully implanted in 4 (80%) of aortic patients, and in 11 (57.9%) of mitral ones. No fatal complications related to the procedure but 1 patient was urgently derived to surgery because of valvular leaflet blocked and another patient got worse hemolysis. Of those patients with mitral success and of those patients with aortic success, 5 (55%) and 3 (75%), respectively, had clinical and echocardiographic improvement at 1 month of clinical follow-up. Interesting, in 1 patient success was achieved on a second attempt.
Conclusions: Percutaneous paraprosthetic leakage closure with the Amplatzer Ductus Occluder is feasible as an alternative in those cases rejected from surgical repair.