title: Percutaneous paravalvular leak reduction: procedural and long-term clinical outcomes.
abstract: BACKGROUND
  Significant paravalvular leak (PVL) after prosthetic replacement can result in hemolysis and/or congestive heart failure (CHF). Percutaneous PVL reduction (PPVR) represents an alternative to repeat surgery for a selected population. The purpose of this study was to assess the procedural and long-term clinical efficacy of percutaneous PPVR and its effect on survival free of rehospitalization for CHF, surgical reintervention, and death.
  
  
  METHODS
  We analyzed a cohort of 56 consecutive patients who underwent 61 PPVRs in our institution between June 2001 and December 2010. Procedural success was defined as a reduction in regurgitation severity free from procedural complications. Patients were followed-up for vital status, clinical events, and symptoms.
  
  
  RESULTS
  Patients were aged 65 ± 11 years, with an average logistic EuroSCORE of 19 ± 14%. Indications for PPVR included CHF (61%), hemolysis (9%), or both (30%), caused by mitral (n = 44) or aortic (n = 12) PVL. Procedural success was achieved in 75% of cases. Three major complications, including 2 deaths, occurred during the initial 30-day follow-up in the 42 patients who were treated with a device. After adjusting for the logistic EuroSCORE, prosthesis type (mitral vs aortic), and time interval since the last valve surgery, a successful PPVR was associated with a better survival free of rehospitalisation for CHF, need for surgical reintervention, and death compared with patients with a failed PPVR. (hazard ratio = 0.34; 95% confidence interval, 0.17-0.71).
  
  
  CONCLUSIONS
  PPVR is associated with a reasonable rate of procedural success and favourable cardiovascular outcomes, and represents an appropriate option when technically possible.
authors.affiliation: From the Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada; From the Department of Medical Specialties, Cardiology Division, Université de Genève, Geneva, Switzerland.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Noble
authors.forename: E Marc
authors.initials: EM
authors.lastname: Jolicoeur
authors.forename: Arsène
authors.initials: A
authors.lastname: Basmadjian
authors.forename: Sylvie
authors.initials: S
authors.lastname: Levesque
authors.forename: Anna
authors.initials: A
authors.lastname: Nozza
authors.forename: Jeannot
authors.initials: J
authors.lastname: Potvin
authors.forename: Jacques
authors.initials: J
authors.lastname: Crépeau
authors.forename: Réda
authors.initials: R
authors.lastname: Ibrahim
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D015331:Cohort Studies; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D006461:Hemolysis; D006801:Humans; D008943:Mitral Valve / Q000601:surgery*; D015999:Multivariate Analysis; D010359:Patient Readmission; D011475:Prosthesis Failure; D055989:Septal Occluder Device; D013997:Time Factors