title: Early experience with the Occlutech PLD occluder for mitral paravalvar leak closure through a hybrid transapical approach.
abstract: OBJECTIVE
  We sought to evaluate the feasibility and efficacy of hybrid transapical closure of paravalvar mitral leaks using a new Occlutech PLD occluder in patients with heart failure and/or haemolytic anaemia.
  
  
  RESULTS
  Retrospective analysis of clinical and procedural data was undertaken for patients who had attempted closure of paravalvar mitral leaks via a hybrid transapical approach with the Occlutech PLD occluder. Eight patients (four males, median age 69 years) underwent closure of 10 mitral paravalvar leaks using eight Occlutech PLD occluders and two AMPLATZER Vascular Plugs (AVP II). Successful deployment, with significant reduction of the paravalvar leak was achieved in seven patients with short procedure (median 131 min) and fluoroscopy times (median 22 min). One patient had mechanical interference with prosthetic valve function, requiring surgery. Another patient with a high EuroSCORE (48.8%) died of multi-organ failure two days after the procedure. Clinical improvement in either heart failure or haemolysis was seen in all discharged patients.
  
  
  CONCLUSIONS
  In our series of patients with challenging anatomy, the Occlutech PLD occluders performed well when implanted via a hybrid transapical approach. Further work is needed to assess this methodology fully for a wider population and to assess other deployment approaches for this promising new occluder.
authors.affiliation: University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
authors.forename: Radwa
authors.initials: R
authors.lastname: Bedair
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Morgan
authors.forename: Vinayak
authors.initials: V
authors.lastname: Bapat
authors.forename: Stamatis
authors.initials: S
authors.lastname: Kapetanakis
authors.forename: Sebastian
authors.initials: S
authors.lastname: Goreczny
authors.forename: John
authors.initials: J
authors.lastname: Simpson
authors.forename: Shakeel A
authors.initials: SA
authors.lastname: Qureshi
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies