Transcatheter closure of paraprosthetic valve leaks after surgical mitral and aortic valve replacements.

Overview

Prosthetic valve replacement surgery is performed in approximately 210,000 patients annually worldwide. At least 3%, and possibly as many as 12.5%, of these valves will eventually demonstrate a clinically important paravalvular leak. Most of the significantly symptomatic leaks are currently repaired surgically, but the risks of repeat operation and re leak are significantly higher than the original valve-replacement surgical risks. Transcatheter closure of paravalvular leaks has been accomplished using a number of different devices in a relatively small number of centers over the last 16 years. Transcatheter paravalvular leak-closure procedures are still evolving. They are associated with very low procedural mortality rates but are technically challenging, variably effective and may require multiple interventions to be clinically successful. Advances in imaging, such as live 3D transesophageal echocardiography, and the development of better occlusion devices that are specifically designed for closing paravalvular leaks may improve procedure times and outcomes. Further development of effective systems for transcatheter paravalvular leak closure could potentially improve the outlook for a significant population of patients with this difficult and sometimes devastating complication of prosthetic valve replacement.