title: Clinical outcomes in patients undergoing percutaneous closure of periprosthetic paravalvular leaks.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the feasibility and efficacy of the percutaneous device closure of a consecutive series of patients with periprosthetic paravalvular leaks referred to our structural heart disease center with congestive heart failure and hemolytic anemia.
  
  
  BACKGROUND
  Clinically significant periprosthetic paravalvular leak is an uncommon but serious complication after surgical valve replacement. Percutaneous closure has been utilized as an alternative to surgical repair of this defect in high-risk surgical patients.
  
  
  METHODS
  This is a retrospective review of 57 percutaneous paravalvular leak closures that were performed in 43 patients (67% male, mean age 69.4 ± 11.7 years) between April 2006 and September 2010. Integrated imaging modalities were used for the evaluation, planning, and guidance of the interventions.
  
  
  RESULTS
  Closure was successful in 86% of leaks and in 86% of patients. Twenty-eight of 35 patients improved by at least 1 New York Heart Association functional class. The percentage of patients requiring blood transfusions and/or erythropoietin injections post-procedure decreased from 56% to 5%. Clinical success was achieved in 89% of the patients in whom procedure was successful. The survival rates for patients at 6, 12, and 18 months after paravalvular leak closures were 91.9%, 89.2%, and 86.5%, respectively. Freedom from cardiac-related death at 42 months post-procedure was 91.9%.
  
  
  CONCLUSIONS
  Percutaneous closure of symptomatic paravalvular leaks, facilitated by integrated imaging modalities has a high rate of acute and long-term success and appears to be effective in managing symptoms of heart failure and hemolytic anemia.
authors.affiliation: Lenox Hill Heart and Vascular Institute,130 East 77th Street, New York, NY 10021-10075, USA. cruiz@nshs.edu
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Ruiz
authors.forename: Vladimir
authors.initials: V
authors.lastname: Jelnin
authors.forename: Itzhak
authors.initials: I
authors.lastname: Kronzon
authors.forename: Yuriy
authors.initials: Y
authors.lastname: Dudiy
authors.forename: Raquel
authors.initials: R
authors.lastname: Del Valle-Fernandez
authors.forename: Bryce N
authors.initials: BN
authors.lastname: Einhorn
authors.forename: Paul T L
authors.initials: PT
authors.lastname: Chiam
authors.forename: Claudia
authors.initials: C
authors.lastname: Martinez
authors.forename: Rocio
authors.initials: R
authors.lastname: Eiros
authors.forename: Gary
authors.initials: G
authors.lastname: Roubin
authors.forename: Howard A
authors.initials: HA
authors.lastname: Cohen
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology