Paravalvular Regurgitation: Clinical Outcomes in Surgical and Percutaneous Treatments.
BACKGROUND
Paravalvular regurgitation (paravalvular leak) is a serious and rare complication associated with valve replacement surgery. Studies have shown a 3% to 6% incidence of paravalvular regurgitation with hemodynamic repercussion. Few studies have compared surgical and percutaneous approaches for repair.


OBJECTIVE
To compare the surgical and percutaneous approaches for paravalvular regurgitation repair regarding clinical outcomes during hospitalization and one year after the procedure.


METHODS
This is a retrospective, descriptive and observational study that included 35 patients with paravalvular leak, requiring repair, and followed up at the Dante Pazzanese Institute of Cardiology between January 2011 and December 2013. Patients were divided into groups according to the established treatment and followed up for 1 year after the procedure.


RESULTS
The group submitted to percutaneous treatment was considered to be at higher risk for complications because of the older age of patients, higher prevalence of diabetes, greater number of previous valve surgeries and lower mean creatinine clearance value. During hospitalization, both groups had a large number of complications (74.3% of cases), with no statistical difference in the analyzed outcomes. After 1 year, the percutaneous group had a greater number of re-interventions (8.7% vs 20%, p = 0.57) and a higher mortality rate (0% vs. 20%, p = 0.08). A high incidence of residual mitral leak was observed after the percutaneous procedure (8.7% vs. 50%, p = 0.08).


CONCLUSIONS
Surgery is the treatment of choice for paravalvular regurgitation. The percutaneous approach can be an alternative for patients at high surgical risk.
Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
Carlos Passos
CP
Pinheiro
Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
Daniele
D
Rezek
Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
Eduardo Paiva
EP
Costa
Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
Edvagner Sergio Leite de
ES
Carvalho
Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
Freddy Antonio Brito
FA
Moscoso
Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
Percy Richard Chavez
PR
Taborga
Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
Andreia Dias
AD
Jeronimo
Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
Alexandre Antonio Cunha
AA
Abizaid
Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
Auristela Isabel de Oliveira
AI
Ramos
D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D001705:Bioprosthesis / Q000009:adverse effects; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D060205:Therapeutic Occlusion / Q000379:methods* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome