title: Percutaneous paravalvular leak closure for balloon-expandable transcatheter aortic valve replacement: a comparison with surgical aortic valve replacement paravalvular leak closure.
abstract: OBJECTIVE
  Paravalvular leak (PVL) is frequently observed after transcatheter aortic valve replacement (TAVR) and is related to increased mortality. Percutaneous PVL closure, which is a viable option for this complication, has been performed following surgical aortic valve replacement (SAVR); however, the experience in TAVR remains limited. We sought to compare this technique between post-TAVR and post-SAVR cases.
  
  
  RESULTS
  A single-center series of patients consecutively undergoing percutaneous PVL closure was reviewed. Each group had 10 cases and procedural/imaging variables were assessed. Although there was no severe complication during the procedures, procedural success rate was lower in the post-TAVR group (60% vs. 100%; P=.04). There was resistance in all 4 unsuccessful cases, and we were unable to advance the delivery sheath over the wire. Computed tomography revealed that unsuccessful cases had higher calcification volume in the corresponding leaflet (351.4 ± 205.1 mm³ vs. 121.8 ± 111.7 mm³; P=.049). This finding can explain the mechanism of difficulty; the higher volume of calcification increases the resistance while advancing the delivery sheath.
  
  
  CONCLUSIONS
  This is the first study revealing the difficulty of percutaneous PVL closure following TAVR compared with SAVR. However, it is a preferred approach in TAVR patients given their high risk for a surgical procedure. Computed tomography assessment of calcification volume provides important information for preprocedural planning.
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA. Raj.Makkar@cshs.org.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Okuyama
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.forename: Mohammad
authors.initials: M
authors.lastname: Kashif
authors.forename: Vikas
authors.initials: V
authors.lastname: Soni
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Wen Loong
authors.initials: WL
authors.lastname: Yeow
authors.forename: Mamoo
authors.initials: M
authors.lastname: Nakamura
authors.forename: Wen
authors.initials: W
authors.lastname: Cheng
authors.forename: Saibal
authors.initials: S
authors.lastname: Kar
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000628:therapy*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000209:etiology