Closure of prosthetic paravalvular leaks: A long way to go

Abstract

Cardiac valve replacement, albeit a well-established and safe procedure, is associated with a significant risk of complications. Symptomatic paravalvular leak (PVL) is a significant post-operative complication of cardiac valve replacement. The prevalence of this complication along with the long-term significance of asymptomatic leaks remains unknown. When these patients develop worsening heart failure or severe haemolysis that requires multiple transfusions from paravalvular regurgitation, the current recommendation is for closure of the leak. The recommended approach has been surgical closure until transcatheter techniques were introduced by Hourihan et al.1 There have been significant innovations in occlusive devices over the past 20 years; however, there are no specifically designed device(s) for the treatment of PVLs. Percutaneous device closure of PVLs has become an attractive alternative to surgical closure. This has further been enhanced by the ability to integrate multiimaging modalities that have helped to define the preoperative anatomy as well as to plan and guide the percutaneous closure procedure, resulting in improved outcomes. © 2010 The Author.