title: Low profile vascular plugs for paravalvular leaks after TAVR.
abstract: BACKGROUND
  Paravalvular leak (PVL) after transcatheter aortic valve replacement (TAVR) is associated with less good outcomes. The use of percutaneous plugs is among the strategies to treat PVL after TAVR. Plugs have been limited by the need to pass 4-6 F delivery sheaths between the TAVR stent frame and the native valve leaflets.
  
  
  METHODS
  The study population consists of six patients who had at least moderate aortic insufficiency (AI), and also developed symptoms of heart failure after TAVR. We describe in detail the use of low profile vascular plugs that require crossing the leaks with only a 4 F diagnostic catheter.
  
  
  RESULTS
  Low profile vascular plugs were successfully deployed in all six patients without significant complications. Fluoroscopy time ranged 16.7-69.4 min (44.8 ± 18.8 min). Contrast volume ranged 15-100 mL (45 ± 34 mL). One plug was used in five, and two adjacent plus in one case. AI severity was reduced from moderate or severe to mild or less in four patients, from severe to moderate in one, and in one, there was no change. Five of six patients were treated electively and were significantly improved in terms of both echocardiographic PVL and also symptoms. The one who did not have echocardiographic improvement did not improve clinically and expired one month later.
  
  
  CONCLUSIONS
  PVL closure can be consistently accomplished after TAVR with low profile vascular plugs. Careful analysis of PVL location on echo before closure greatly facilitates finding the fluoroscopic location of the leak. Decreases in PVL severity are associated with significant clinical improvement.
authors.affiliation: Cardiovascular Division, NorthShore University HealthSystem, Evanston, Illinois.
authors.forename: Ted
authors.initials: T
authors.lastname: Feldman
authors.forename: Michael H
authors.initials: MH
authors.lastname: Salinger
authors.forename: Justin P
authors.initials: JP
authors.lastname: Levisay
authors.forename: Steven
authors.initials: S
authors.lastname: Smart
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation*; D062906:Cardiac Catheters; D003287:Contrast Media; D004867:Equipment Design; D005260:Female; D005471:Fluoroscopy; D006333:Heart Failure / Q000209:etiology / Q000628:therapy; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D015641:Radiography, Interventional / Q000379:methods; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000628:therapy
chemical_list: D003287:Contrast Media
keywords: TAVR; paravalvular leak; percutaneous closure; vascular plug