Device closure of periprosthetic paravalvular regurgitation

Abstract

Periprosthetic paravalvular regurgitation is an important sequel associated with prosthetic valves whether implanted surgically or via transcatheter approach. They can remain clinically silent or manifest as clinical heart failure, intravascular hemolysis or a combination of both. Periprosthetic defects are becoming increasingly recognized as a source of morbidity and mortality in patients with prosthetic heart valves and in the last few years, the management of this condition has evolved. This review aims to address the current knowledge on the pathophysiology, imaging modalities and management of these defects. It further details the principles, methodology and outcomes of catheter-based device therapy of periprosthetic paravalvular defects.

Keywords:

• closure devices
• heart failure
• periprosthetic defects
• prosthetic heart valves
• transcatheter therapy

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Periprosthetic paravalvular regurgitation is becoming an increasingly recognized complication of surgical and transcatheter valve replacement.

• The incidence of periprosthetic insufficiency is variable and differs between aortic and mitral valve replacements but accounts for 5–9% of re-do valve surgery.

• Clinical manifestations of significant PVL are either hemolysis or heart failure or a combination of both.

• Re-do valve surgery has long been the main stay of treatment but is associated with increased morbidity and mortality.

• Percutaneous closure of these defects has become a viable alternative and is being increasingly used as first-line therapy.

• Appropriate cardiac imaging with TTE, TEE and ICE along with fluoroscopy is crucial to achieve excellent success rates with percutaneous closure.

• Multiple devices and approaches can be used to achieve percutaneous closure.

• There is increasing evidence supporting the benefit of percutaneous closure of these defects on quality of life, cardiac remodeling, improved functional class and improved morbidity and mortality.

Notes

TAVR: Transcatheter aortic valve replacement; LVOT: Left ventricular outflow tract.

SVR: Surgical valve replacement.