title: Outcome of paravalvular leak repair after transcatheter aortic valve replacement with a balloon-expandable prosthesis.
abstract: BACKGROUND
  Significant paravalvular leak (PVL) occurs in up to 13% of patients after transcatheter aortic valve replacement (TAVR) with a balloon-expandable bioprosthesis. Transcatheter PVL repair has emerged as a less invasive alternative for this problem.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the safety, feasibility, and clinical outcomes of transcatheter PVL repair after TAVR with balloon-expandable valve.
  
  
  METHODS
  We retrospectively identified 15 patients who underwent 16 PVL repair procedures after the TAVR at our center. Procedural characteristics, results, and clinical outcomes were analyzed. The association of PVL repairs with subsequent hospitalizations and mortality was assessed and compared to 57 patients who did not undergo repair for at least moderate PVL after TAVR.
  
  
  RESULTS
  The PVL repair was successful in 13 (87%) patients, without significant procedure or device related complications. In patients with successful PVL repair, there was an improvement in symptom status, subsequent hospitalizations, and B-type natriuretic peptide levels. There was 1 (out of 13, 8%) death in the group of patients who successfully underwent PVL repair whereas 24 (out of 57, 42%) patients died during follow up in the group that did not undergo repair of their PVL. Similarly, there was significant reduction in the subsequent heart failure related hospitalization after the PVL repair, compared with the patients who did not undergo PVL repair (P = 0.03).
  
  
  CONCLUSIONS
  Transcatheter repair of PVL after TAVR can be safely and effectively accomplished in carefully selected patients, and may lead to reduction in hospitalizations, improvement in symptoms, and long-term survival. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Suite A 3600, Los Angeles, California, 90048.|University of Texas Health Science Center, 6431 Fannin St, MSB 1.224, Houston, Texas, 77030.
authors.forename: Abhijeet
authors.initials: A
authors.lastname: Dhoble
authors.affiliation: Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Suite A 3600, Los Angeles, California, 90048.
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.affiliation: Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Suite A 3600, Los Angeles, California, 90048.
authors.forename: Mamoo
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Suite A 3600, Los Angeles, California, 90048.
authors.forename: Yigal
authors.initials: Y
authors.lastname: Abramowitz
authors.affiliation: Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Suite A 3600, Los Angeles, California, 90048.
authors.forename: Rikin
authors.initials: R
authors.lastname: Tank
authors.affiliation: Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Suite A 3600, Los Angeles, California, 90048.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Mihara
authors.affiliation: Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Suite A 3600, Los Angeles, California, 90048.
authors.forename: Geeteshwar
authors.initials: G
authors.lastname: Mangat
authors.affiliation: Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Suite A 3600, Los Angeles, California, 90048.
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.affiliation: Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Suite A 3600, Los Angeles, California, 90048.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Shiota
authors.affiliation: Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd, Suite A 3600, Los Angeles, California, 90048.
authors.forename: Raj
authors.initials: R
authors.lastname: Makkar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D063126:Balloon Valvuloplasty; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D018572:Disease-Free Survival; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D015141:Los Angeles; D008297:Male; D010359:Patient Readmission; D018579:Patient Selection; D011474:Prosthesis Design; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: aortic stenosis; paravalvular leak; transcatheter aortic valve replacement