Introduction and objectives Percutaneous paravalvular leak closure is a complex procedure with varying success rates; the lack of closure devices specifically designed for this purpose has hampered this technique. The characteristics of the Amplatzer Vascular Plug III appear to be well suited for paravalvular leak closures; however, the available data are limited to case reports or small series of patients. The aim of this study was to analyze the feasibility and efficacy of paravalvular leak with this device. Methods The immediate and 90-day safety and efficacy of mitral and aortic paravalvular leak closures performed with this device at our hospital were analyzed. Results Percutaneous repair of 34 paravalvular leaks (27 mitral, 7 aortic) was attempted in 33 patients. The device was successfully implanted in 93.9% (in 2 patients, a second planned procedure was needed), and successful closure (defined as regurgitation reduction ≥ 1 grade) was achieved in 90.9% of patients. Complications included emergency surgery due to disc interference (n = 1) and blood transfusion (n = 3). There were no reports of procedure-related death, myocardial infarction, or stroke. At 90 days, survival was 100%, and 90.3% of patients showed significant clinical improvement; 4 patients developed vascular complications (pseudoaneurysm). Conclusions Mitral and aortic paravalvular leak closure with the Amplatzer Vascular Plug  III is feasible and safe, with high clinical and echocardiographic success rates.

Paravalvular Leak Closure With the Amplatzer Vascular Plug III Device: Immediate and Short-term Results

Resumen Introduccion y objetivos El cierre percutaneo de las fugas periprotesicas presenta tasas de exito variables, la falta de dispositivos especificamente disenados para este procedimiento ha limitado sus resultados. El Amplatzer Vascular Plug  III , por sus caracteristicas, parece un dispositivo ideal para este procedimiento, pero los datos disponibles se limitan a casos aislados o pequenas series. El proposito de este estudio es analizar la factibilidad y la eficacia del cierre percutaneo de fugas periprotesicas con este dispositivo. Metodos Se analizan resultados de seguridad y eficacia durante el procedimiento y a 90 dias de las fugas periprotesicas mitrales y aorticas cerradas percutaneamente con este dispositivo en nuestro centro. Resultados Se trataron 34 fugas periprotesicas, 7 a nivel aortico y 27 a nivel mitral, correspondientes a 33 pacientes. El exito tecnico fue del 93,9% (en 2 pacientes se realizo un segundo procedimiento programado) y el exito del procedimiento (reduccion ≥ 1 grado de regurgitacion) en el 90,9%. En 4 pacientes se observaron complicaciones relacionadas con el procedimiento (transfusion en 3 pacientes y cirugia por interferencia con los discos en 1 paciente). No se observo ningun caso de muerte, infarto de miocardio o accidente cerebrovascular periprocedimiento. A 90 dias la supervivencia fue del 100%, y en el 90,3% de los pacientes mejoro la clase funcional; 4 pacientes sufrieron complicaciones vasculares (seudoaneurisma) en el seguimiento. Conclusiones El cierre percutaneo de la fugas periprotesicas con el Amplatzer Vascular Plug  III es un procedimiento factible, seguro y con elevadas tasas de exito clinico y ecocardiografico.

Cierre percutáneo de fugas periprotésicas con el dispositivo Amplatzer Vascular Plug III : resultados inmediatos y a corto plazo

https://www.annalsthoracicsurgery.org/article/S0003-4975(16)00126-0/pdf

How Local Annular Force and Collagen Density Govern Mitral Annuloplasty Ring Dehiscence Risk

Objectives Mitral valve (MV) annuloplasty ring dehiscence with subsequent recurrent mitral regurgitation represents an unusual but challenging clinical problem. Incidence, localization and outcomes for this complication have not been well defined. Methods From 1996 to 2016, a total of 3478 patients underwent isolated MV repair with ring annuloplasty at the Leipzig Heart Centre. Of these patients, 57 (1.6%) underwent reoperation due to annuloplasty ring dehiscence. Echocardiographic data, operative and early postoperative characteristics as well as short- and long-term survival rates after MV reoperation were analysed. Results Occurrences of ring dehiscence were acute ( 1 year) in 44%, 33% and 23% of patients, respectively. Localization of annuloplasty ring dehiscence was found most frequently in the P3 segment (68%), followed by the P2 (51%) and the P1 segments (47%). The 30-day mortality rate and 1- and 5-year survival rates after MV reoperation were 2%, 89% and 74%, respectively. During reoperation, MV replacement was performed in 38 (67%) and MV re-repair in 19 (33%) patients. Conclusions Annuloplasty ring dehiscence is clinically less common, localized more frequently on the posterior annulus and occurs mostly acutely or early after MV repair. MV reoperation can be performed safely in such patients.

Annuloplasty ring dehiscence after mitral valve repair: incidence, localization and reoperation.

Mitral annuloplasty ring flexibility preferentially reduces posterior suture forces.

Percutaneous Closure of Mitral Paravalvular Leak

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Percutaneous Closure of Mitral Paravalvular Leak