title: Paravalvular leak closure after transcatheter aortic valve replacement with a self-expanding prosthesis.
abstract: BACKGROUND
  Paravalvular leak (PVL) after percutaneous transcatheter aortic valve replacement (TAVR) is associated with significant morbidity and mortality. Percutaneous PVL closure has been reported for balloon-expandable valves but not self-expandable valves.
  
  
  METHODS
  We conducted a review of cases at our center where patients who received TAVR with self-expandable valves and went on to develop severe PVL underwent percutaneous closure. Baseline demographic, TAVR procedural, PVL procedural, and follow-up data were collected.
  
  
  RESULTS
  A total of five patients with severe PVL after TAVR with a self-expanding valve underwent percutaneous PVL closure. Four of five patients had a trial of balloon postdilatation after valve deployment and had significant persistent PVL. In all five patients, PVL went from moderate-severe to mild-moderate PVL. There were no adverse events.
  
  
  CONCLUSIONS
  Percutaneous PVL closure for severe PVL self-expanding valve for TAVR is a safe and efficacious procedure. Procedural technique involves transesophageal guidance, a high approach through the valve struts, deployment of an appropriate size device, and careful monitoring. This method may be part of the algorithm for severe PVL after TAVR.
authors.affiliation: Cardiovascular Center Frankfurt, Frankfurt, Germany.
authors.forename: Sameer
authors.initials: S
authors.lastname: Gafoor
authors.forename: Jennifer
authors.initials: J
authors.lastname: Franke
authors.forename: Kerstin
authors.initials: K
authors.lastname: Piayda
authors.forename: Simon
authors.initials: S
authors.lastname: Lam
authors.forename: Stefan
authors.initials: S
authors.lastname: Bertog
authors.forename: Laura
authors.initials: L
authors.lastname: Vaskelyte
authors.forename: Ilona
authors.initials: I
authors.lastname: Hofmann
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*
keywords: CoreValve; paravalvular leak closure; replacement; self-expanding; transcatheter aortic valve implantation