title: Hybrid approach for transcatheter paravalvular leak closure of mitral prosthesis in high-risk patients through transapical access.
abstract: OBJECTIVE
  To report "hybrid" procedure feasibility and the clinical success of transcatheter paravalvular leak closure through apical access.
  
  
  METHODS
  Seven patients (73.6±6.1 years; 4 men) with severe mitral prosthesis paravalvular leak were selected. All patients were at high risk for open surgery because of severe comorbidities and heart failure (New York Heart Association class III-IV).
  
  
  RESULTS
  The defect size was 25±7.8 mm in the long axis and 9.3±2 mm in the short axis. Two defects were detected in 2 patients. The transapical procedure was performed in a "hybrid" surgery room using minithoracotomy and general anesthesia. Three-dimensional transesophageal echocardiography and fluoroscopy were used for imaging. A total of 19 Amplatzer Vascular Plug III devices (St Jude Medical) were implanted in 7 patients, 2.7/patient and 1 to 3/fistula. The procedure time was 150.7±66.8 minutes. In 6 of 7 patients (85.7%), the paravalvular leak was successfully closed, resulting in no or mild residual regurgitation. One patient had moderate regurgitation despite deployment of 3 Amplatzer Vascular Plug III devices. Two patients required blood transfusion related to procedural blood loss. The patients were discharged at 15.3±6.5 days and followed up at 215.7±138.6 days. All but 1 patient reported symptomatic improvement by ≥1 New York Heart Association class at follow-up. One patient died 216 days postoperatively.
  
  
  CONCLUSIONS
  A "hybrid approach" for transcatheter paravalvular leak closure of mitral prosthesis from the apical route is effective in reducing the regurgitation grade and improving functional capacity in high-risk patients. Complete closure of the defect was maintained at follow-up in most patients.
authors.affiliation: Centre of Cardiology and Angiology, Vilnius University, Vilnius, Lithuania. Electronic address: giedrius.davidavicius@santa.lt.
authors.forename: Giedrius
authors.initials: G
authors.lastname: Davidavicius
authors.affiliation: Centre of Cardiac Surgery, Vilnius University, Vilnius, Lithuania.
authors.forename: Kestutis
authors.initials: K
authors.lastname: Rucinskas
authors.affiliation: Centre of Cardiology and Angiology, Vilnius University, Vilnius, Lithuania.
authors.forename: Agne
authors.initials: A
authors.lastname: Drasutiene
authors.affiliation: Centre of Anesthesiology, Vilnius University, Vilnius, Lithuania.
authors.forename: Robertas
authors.initials: R
authors.lastname: Samalavicius
authors.affiliation: Centre of Cardiology and Angiology, Vilnius University, Vilnius, Lithuania.
authors.forename: Valdas
authors.initials: V
authors.lastname: Bilkis
authors.affiliation: Centre of Cardiology and Angiology, Vilnius University, Vilnius, Lithuania.
authors.forename: Diana
authors.initials: D
authors.lastname: Zakarkaite
authors.affiliation: Centre of Cardiology and Angiology, Vilnius University, Vilnius, Lithuania.
authors.forename: Audrius
authors.initials: A
authors.lastname: Aidietis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D015641:Radiography, Interventional; D012086:Reoperation; D012307:Risk Factors; D013908:Thoracotomy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome