Procedural Tools and Technics for Transcatheter Paravalvular Leak Closure: Lessons from a Decade of Experience.
Sébastien HascoëtGrzegorz SmolkaTeoman KilicReda IbrahimEustaquio Maria OnoratoPatrick A CalvertDidier ChampagnacXavier Freixa-RofastesAleksejus ZorinasJuan Pablo SandovalGregory DucrocqFrédéric BouissetAlain FraisseBenoit Gerardinnull nullPublished in: Journal of clinical medicine (2022)
Prosthetic paravalvular leaks (PVLs) are associated with congestive heart failure and hemolysis. Surgical PVL closure carries high risks. Transcatheter implantation of occluding devices in PVL is a lower risk but challenging procedure. Of the available devices, only two have been specifically approved in Europe for transcatheter PVL closure (tPVLc): the Occlutech ® Paravalvular Leak Device (PLD) and Amplatzer™ ParaValvular Plug 3 (AVP 3). Here, we review the various tools and devices used for tPVLc, based on three observational registries including 748 tPVLc procedures performed in 2005-2021 at 33 centres in 11 countries. In this case, 12 registry investigators with over 20 tPVLc procedures each described their practical tips and tricks regarding imaging, approaches, delivery systems, and devices. They considered three-dimensional echocardiography to be the cornerstone of PVL assessment and procedure guidance. Anterograde trans-septal mitral valve and retrograde aortic approaches were used in most centres, although some investigators preferred the transapical approach. Hydrophilic-coated low-profile sheaths were used most often for device deployment. The AVP 3 and PLD devices were chosen for 89.0% of procedures. Further advances in design and materials are awaited. These complex procedures require considerable expertise, and experience accumulated over a decade has no doubt contributed to improve practices.
Keyphrases
- transcatheter aortic valve replacement
- mitral valve
- transcatheter aortic valve implantation
- heart failure
- left ventricular
- aortic valve
- aortic stenosis
- healthcare
- computed tomography
- pulmonary hypertension
- left atrial
- high resolution
- coronary artery
- cross sectional
- pulmonary artery
- risk assessment
- mass spectrometry
- climate change
- human health