title: Outcomes After Paravalvular Leak Closure: Transcatheter Versus Surgical Approaches.
abstract: The aim of this study was to compare outcomes of transcatheter intervention (TI) versus surgical intervention (SI) for paravalvular leak (PVL).
  
  
  
  Data comparing the treatment of PVL with TI and SI are limited.
  
  
  
  A retrospective cohort study was conducted comparing baseline characteristics, procedural details, and 1-year survival in consecutive patients who underwent TI or SI for moderate or greater PVL from 2007 to 2016. The primary outcome was a composite of death, reintervention for PVL, or readmission for congestive heart failure-related symptoms at 1 year.
  
  
  
  Of 114 patients, 56 underwent TI and 58 underwent SI. PVL locations were mitral, aortic, and pulmonary in 69 (60.5%), 39 (34.2%), and 6 (5.3%) patients, respectively. At baseline, TI patients were older (age 71 vs. 62 years; p = 0.010) and had fewer cases of active endocarditis (0.0% vs. 25.9%, p < 0.001) than SI patients. The TI group had a shorter post-operative stay (4 vs. 8 days; p < 0.001), a shorter intensive care unit stay (0 vs. 3 days; p < 0.001), and fewer readmissions at 30 days (8.9% vs. 25.9%; p = 0.017). There were no differences in the primary endpoint (TI 33.9% vs. SI 39.7%; p = 0.526) or 1-year survival (TI 83.9% vs. SI 75.9%; p = 0.283) between groups.
  
  
  
  In this study, TI for PVL closure had comparable 1-year clinical outcomes with SI, even after adjusting for differences in baseline characteristics, with less in-hospital morbidity and 30-day rehospitalization. Although further study is needed, these findings support the increased implementation of TI for PVL closure at experienced institutions.
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: John A
authors.initials: JA
authors.lastname: Wells
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Jose F
authors.initials: JF
authors.lastname: Condado
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Kamioka
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Andy
authors.initials: A
authors.lastname: Dong
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ritter
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Stamatios
authors.initials: S
authors.lastname: Lerakis
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Clements
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: James
authors.initials: J
authors.lastname: Stewart
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Bradley
authors.initials: B
authors.lastname: Leshnower
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Robert
authors.initials: R
authors.lastname: Guyton
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Jessica
authors.initials: J
authors.lastname: Forcillo
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Ateet
authors.initials: A
authors.lastname: Patel
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Block
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia. Electronic address: vbabali@emory.edu.
authors.forename: Vasilis
authors.initials: V
authors.lastname: Babaliaros
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D005260:Female; D005845:Georgia; D006333:Heart Failure / Q000209:etiology / Q000628:therapy; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D006351:Heart Valves / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D016896:Treatment Outcome
keywords: paravalvular leak; surgery; transcatheter; valve repair; valve replacement