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Percutaneous paravalvular leak closure for symptomatic aortic regurgitation after C ore V alve transcatheter aortic valve implantation
Author(s) -
Arri Satpal S.,
Poliacikova P.,
HildickSmith D.
Publication year - 2015
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.25730
Subject(s) - medicine , regurgitation (circulation) , percutaneous , leak , cardiology , aortic valve , surgery , aortic valve replacement , adverse effect , stenosis , environmental engineering , engineering
Objectives We present a case series of five patients in whom percutaneous paravalvular leak closure with the AVP4 device has been undertaken for symptomatic aortic regurgitation after CoreValve TAVI. Background Significant post‐procedure aortic regurgitation (AR) is often difficult to assess, and is an important predictor of adverse outcome following TAVI. Paravalvular leak closure is an established procedure for surgical aortic prostheses, and has been undertaken for Edwards TAVIs, but has not been described for closure of CoreValve paravalvular leaks.Methods and Results Five patients were treated (mean age 81 ± 4 years) with residual grade 3–4 AR following placement of a single CoreValve ( n = 2), double CoreValve ( n = 2) or CoreValve within a bioprosthetic AVR ( n = 1). The mean time post TAVI implantation was 308 ± 269 days. All patients were symptomatic with persistent NYHA Grade III dyspnoea. 6 devices were deployed successfully, with mean procedure time of 109 ± 23 min. There were no procedural complications and all patients were discharged home by Day 2. Residual AR after treatment was grade 0 ( n = 2), grade 1 ( n = 1), grade 2 ( n = 1) and grade 3 ( n = 1). Symptomatic improvement was noted in all 4 patients who have been reviewed in clinic since. Conclusions This small series demonstrates the feasibility of paravalvular leak closure with the CoreValve TAVI, despite the adverse aortic lattice. The AVP4 device is ideally suited to this situation as it will pass through a 0.038' lumen and can therefore be delivered down standard diagnostic catheters. © 2014 Wiley Periodicals, Inc.