Abstract 10914: Percutaneous Repair of Paravalvular Prosthetic Regurgitation: Acute and 30-Day Outcomes in 103 Patients
Background: Percutaneous repair has emerged as a potential therapy for patients with peri-prosthetic valvular regurgitation. However, there is a paucity of data on feasibility and outcome of the procedure.
Methods: Percutaneous repair of 127 defects due to paravalvular regurgitation was attempted in 103 patients (age, 67±12 yrs; 52% men) with heart failure or hemolytic anemia, and who were at high risk of open surgery (estimated STS mortality, 7.1±5.9%). Under echocardiographic and fluoroscopic guidance, patients underwent implantation of an Amplatzer® Septal Occluder (n=15), Duct Occluder (n=20), VSD Occluder (n=11), or Vascular Plug II (n=70) devices.
Results: Wire exteriorization was required for device delivery in 28 patients. Devices were implanted in 111 defects (87% of total), including 13 patients with multiple defects. Procedural time was shorter for repair of peri-aortic regurgitation (n=18, 137±60 min) in comparison to peri-mitral lesions (n=85, 155±54 min). For repair of peri-mitral regurgitation, significant improvement in procedure time occurred with case experience (Figure). Overall, successful percutaneous closure with moderate or less residual regurgitation was achieved in 91 patients (88%). The 30-day complication rate was 9.7%, including two device embolizations, two patients with hemothorax, two strokes, and one patient who underwent emergency surgery for leaflet impingement. Early mortality rate was low (1 death or 0.9%).
Conclusions: Percutaneous repair of paravalvular prosthetic regurgitation can be performed with a high rate of procedural success, and may be preferred in patients at significant peri-operative risk. Increased case experience is associated with shorter procedure time.
- © 2010 by American Heart Association, Inc.