title: Two-Year Follow Up After Surgical Versus Percutaneous Paravalvular Leak Closure: A Non-Randomized Analysis.
abstract: BACKGROUND
  Percutaneous closure of paravalvular leak (PVL) has emerged as an alternative treatment. Predictors of survival and procedural success are unknown.
  
  
  OBJECTIVE
  To review our experience in the treatment of PVL and evaluate efficacy, mortality, predictors of success, and outcomes.
  
  
  METHODS
  Retrospective review of percutaneous PVL procedures between years 2008 and 2014. Survival and results were compared with a control cohort of surgical patients.
  
  
  RESULTS
  Percutaneous closure was attempted in 51 patients. The surgical group had 36 patients. Defects were perimitral in 67 patients (77%). Mean follow-up (FU) was 784.5 days. After propensity score analysis in-hospital mortality was higher in the surgical group (30.6% vs. 9.8%, OR 6, P 0.01). Clinical improvement was higher in the percutaneous group (71.4% vs. 36.4%, P 0.002). Multivariate analysis showed normal creatinine (OR 15, P < 0.001) as independent predictor of clinical improvement. For the composite end-point of all-cause mortality or readmission, older age (OR 10.7, P 0.001), renal failure, (OR 18, P < 0.01), poor functional class and the absence of clinical improvement (OR 3.9, P < 0.001) were related with a higher risk. There were no differences in survival free from the composite end-point according to the treatment received (surgical or percutaneous).
  
  
  CONCLUSIONS
  Percutaneous PVL closure has a reasonable rate of success and low complication rates, and results compare favorably with surgical treatment. Older patients and those with poor functional class or renal failure (RF) showed a worse prognosis even after a successful closure. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Instituto De Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Departamento De Medicina, Madrid, Spain. rocioang1@hotmail.com.
authors.forename: Rocío
authors.initials: R
authors.lastname: Angulo-Llanos
authors.affiliation: Instituto De Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Departamento De Medicina, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Sarnago-Cebada
authors.affiliation: Instituto De Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Departamento De Medicina, Madrid, Spain.
authors.forename: Allan R
authors.initials: AR
authors.lastname: Rivera
authors.affiliation: Instituto De Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Departamento De Medicina, Madrid, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Elízaga Corrales
authors.affiliation: Departamento De Cirugía Cardiaca, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Cuerpo
authors.affiliation: Instituto De Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Departamento De Medicina, Madrid, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Solis
authors.affiliation: Instituto De Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Departamento De Medicina, Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Gutierrez-Ibañes
authors.affiliation: Instituto De Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Departamento De Medicina, Madrid, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Sanz-Ruiz
authors.affiliation: Instituto De Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Departamento De Medicina, Madrid, Spain.
authors.forename: M E
authors.initials: ME
authors.lastname: Vázquez Álvarez
authors.affiliation: Instituto De Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Departamento De Medicina, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernandez-Avilés
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D011474:Prosthesis Design; D011475:Prosthesis Failure; D051437:Renal Insufficiency / Q000150:complications; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
keywords: paravalvular leak; percutaneous closure; pulmonary hypertension