Transapical treatment of paravalvular leaks in patients with a logistic euroscore of more than 15%

Objective : We describe the short‐term results of the patients who underwent transapical treatment of a paravalvular leak (PVL) in our centre. Background : Increasing experience with transapical aortic valve implantation has inspired us to explore this approach for prosthetic paravalvular leak reduction in high risk patients. Methods : All procedures were performed in the catheterization laboratory under general anesthesia, using a small anterolateral thoracotomy to expose the apex. Access through a 9‐French sheath was necessary to introduce the Amplatzer Vascular III plug. Three‐dimensional transesophageal echocardiography (3D‐TEE) was used to guide the operator and evaluate the severity of regurgitation postimplantation. Results : In total seven consecutive patients (mean age 72.8 ± 5.6 years, 86% male) with a history of mitral valve ( n = 6) or aortic valve replacement and severe PVL, underwent transapical PVL reduction using seven plugs in total (diameter 10–14 mm). Preprocedural median logistic EuroSCORE was 28.5% (range 17.1–41.1%) and NYHA functional class was ≥3 in all patients. The procedure was successful in all patients, with a median fluoroscopic time of 18.7 min (range 10.1–29.6 min). Postprocedure 3D‐TEE showed occlusion of PVL in three patients, and significant reduction in three patients. Postprocedural complication was a hematothorax requiring surgery in one patient. Median hospitalization duration after the procedure was 5 days (range 5–59 days). At 3‐month follow‐up one patient died, functional class and LDH did not differ significantly and there was a significant increase in hemoglobin. Conclusions : Transapical paravalvular leak reduction might be a good or rather attractive alternative in high‐risk patients for major re‐do cardiac surgery. © 2011 Wiley Periodicals, Inc.