Hopscotch technique: A novel method for percutaneous closure of paravalvular leaks.
OBJECTIVE
To describe the feasibility and safety of the Hopscotch Technique, a novel method to close paravalvular leaks.


BACKGROUND
Successful closure of paravalvular leaks requires the complete seal of irregular defects, frequently interrupted by remaining sutures or tissue that converts a large defect into a complex series of contiguous smaller defects. Successful treatment with devices placed in a single space is impossible with constrained appearance and significant residual leak; therefore, new techniques to deploy smaller devices in the correct location are needed.


METHODS
We retrospective analyzed all the patients with mitral PVLs undergoing percutaneous closure with the Hopscotch technique from November 2011 to January 2016.


RESULTS
Sixteen procedures were performed in 15 patients (median age 66-year-old, 67% male, STS 3.9%), most of them with biological prostheses (73%). Mean PVL size was 12.5 mm located in the lateral position. Percutaneous transapical access was the final approach in nine procedures and success of the procedure was achieved in 12. Usually, the technique was performed by 1 Hopscotch crossing/jump; however, complex procedures requiring 2 or 3 crossings were utilized in 4 patients, even possible between aortic and mitral leaks along the aortic-mitral continuity. Residual mitral paravalvular regurgitation of ≤mild was achieved in 93% of procedures.


CONCLUSIONS
The Hopscotch technique is feasible and safety for patients with mitral paravalvular leak when boundaries prevent full device expansion. © 2017 Wiley Periodicals, Inc.
Hackensack University Medical Center and the Joseph M Sanzari Children's Hospital, Hackensack, New Jersey.
Carlos E
CE
Ruiz
Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
Li
L
Chi-Hion
Hackensack University Medical Center and the Joseph M Sanzari Children's Hospital, Hackensack, New Jersey.
Jelnin
J
Vladimir
North Shore LIJ Health System, Lenox Hill Heart and Vascular Institute of New York, New York.
Perk
P
Gila
North Shore LIJ Health System, Lenox Hill Heart and Vascular Institute of New York, New York.
Weiss
W
Dillon
North Shore LIJ Health System, Lenox Hill Heart and Vascular Institute of New York, New York.
Kronzon
K
Itzhak
North Shore LIJ Health System, Lenox Hill Heart and Vascular Institute of New York, New York.
Kliger
K
Chad
D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D018618:Echocardiography, Doppler, Color; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000601:surgery*; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies
cardiac valve prosthesis; echocardiography; four dimensional computed tomography; heart failure; mitral valve regurgitation; transesophageal