title: Immediate and mid-term clinical course after percutaneous closure of paravalvular leakage.
abstract: OBJECTIVE
  Percutaneous closure of paravalvular leakage is an alternative to surgery in high-risk patients, but its use has been limited by a lack of specific devices. More appropriate devices-like the Amplatzer Vascular Plug III-have recently been developed, but information about their efficacy and safety is still scarce. The objective of the present study was to assess the mid-term results of paravalvular leakage closure with this device.
  
  
  METHODS
  We analyzed the clinical and echocardiographic course both in-hospital and mid-term (13 [9] months) in a series of 20 consecutive patients (age, 68 years; logistic EuroSCORE, 29) with paravalvular leakage and attempted percutaneous closure.
  
  
  RESULTS
  Closure was attempted for 23 leaks (17 mitral and 6 aortic) during 22 procedures in 20 patients. Implantation was successful in 87% of the leaks and the procedure was successful in 83%-with success being defined as a reduction in regurgitation of ≥ 1 degree. Survival at 1 year was 64.7% and survival free of the composite event of death/surgery was 58.8%. The degree of residual regurgitation was not associated with mortality but was associated with functional status. Survivors showed significant improvement in functional class.
  
  
  CONCLUSIONS
  Percutaneous closure of leakage with the Amplatzer Vascular Plug III is safe and efficient in the mid-term. However, mortality among high-risk patients is high independently of the degree of residual regurgitation, indicating that these procedures are performed when heart disease has reached an advanced stage.
authors.affiliation: Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain. Electronic address: recalde@secardiologia.es.
authors.forename: Angel
authors.initials: A
authors.lastname: Sánchez-Recalde
authors.affiliation: Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Raúl
authors.initials: R
authors.lastname: Moreno
authors.affiliation: Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Galeote
authors.affiliation: Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Jimenez-Valero
authors.affiliation: Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Calvo
authors.affiliation: Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Joel Hernández
authors.initials: JH
authors.lastname: Sevillano
authors.affiliation: Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Arroyo-Ucar
authors.affiliation: Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: López
authors.affiliation: Servicio de Cirugía Cardiovascular, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Mesa
authors.affiliation: Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: José L
authors.initials: JL
authors.lastname: López-Sendón
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D011475:Prosthesis Failure; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cardiac catheterization; Cateterismo cardiaco; Dehiscencia paravalvular; Device; Dispositivo; Paravalvular leakage; Prosthetic valve; Prótesis valvular; Supervivencia; Survival