title: Techniques and Outcomes of Percutaneous Aortic Paravalvular Leak Closure.
abstract: The aim of this study is to provide a summary of the currently applied aortic paravalvular leak (PVL) closure techniques and describe the procedural and long-term outcomes in a large consecutive cohort of patients.
  
  
  
  Percutaneous repair has emerged as an effective therapy for patients with PVL. To date, clinical outcome data on percutaneous closure of aortic PVL are limited.
  
  
  
  All patients who underwent catheter-based treatment of aortic PVL between 2006 and 2015 were identified. Procedural and short-term results were assessed. Patients were contacted for clinical events and symptoms.
  
  
  
  Eighty-six procedures were performed in 80 patients. The mean age was 68 ± 15 years, and 70% were men. The primary indications for PVL closure were symptoms of heart failure, hemolysis, and both in 83%, 5%, and 12%, respectively. Successful device deployment was accomplished in 94 defects (90%). Reduction in PVL to mild or less was achieved in 62% of patients. In-hospital major adverse events occurred in 8% of procedures. Symptomatic improvement at 30 days was achieved in 64% of patients. Patients who had reduction in the PVL grade to mild or less experienced more improvement in New York Heart Association functional class (from 2.93 ± 0.62 to 1.72 ± 0.73) compared with those with mild or greater residual leak (from 3.03 ± 0.57 to 2.52 ± 0.74) (p < 0.001). In patients with severe hemolysis (n = 8), transfusion requirements were eliminated in 7 (88%) after PVL closure. Kaplan-Meier survival analysis showed that the cumulative probability of freedom from repeat surgery at 2 years was 98 ± 2% in patients who had mild or less residual leak compared with 68 ± 10% in patients with higher grades of residual PVL (log-rank p = 0.004).
  
  
  
  Percutaneous reduction of aortic PVL is associated with durable symptom relief and lower rates of repeat cardiac surgery. The magnitude of benefit is greatest with PVL reduction to a grade of mild or less. Therefore, attempts should be made to reduce PVL as much as possible.
authors.affiliation: Divisions of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Alkhouli
authors.affiliation: Divisions of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Sarraf
authors.affiliation: Divisions of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Elad
authors.initials: E
authors.lastname: Maor
authors.affiliation: Divisions of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Sanon
authors.affiliation: Divisions of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Allison
authors.initials: A
authors.lastname: Cabalka
authors.affiliation: Divisions of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Mackram F
authors.initials: MF
authors.lastname: Eleid
authors.affiliation: Divisions of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Hagler
authors.affiliation: Divisions of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Peter
authors.initials: P
authors.lastname: Pollak
authors.affiliation: Divisions of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Guy
authors.initials: G
authors.lastname: Reeder
authors.affiliation: Divisions of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota. Electronic address: rihal@mayo.edu.
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D018572:Disease-Free Survival; D018618:Echocardiography, Doppler, Color; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D004867:Equipment Design; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: aortic regurgitation; paravalvular leak; percutaneous repair