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Reading: Percutaneous Repair of Mitral Paravalvular Regurgitation

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Percutaneous Repair of Mitral Paravalvular Regurgitation

Authors:

Sashi Guthikonda ,

From Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
About Sashi
M.D., M.P.H.
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William A. Zoghbi,

From Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
About William A.
M.D.
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Neal S. Kleiman,

From Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
About Neal S.
M.D.
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Stephen H. Little

From Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
About Stephen H.
M.D.
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Abstract

Surgical replacement with either a mechanical or bioprosthetic valve remains the mainstay for most adult valve disorders. Though long-term prognosis in most cases after surgery is excellent, one possible complication is a paravalvular leak. Paravalvular leaks are leakages around the implanted prosthesis, the reported incidence of which is between 1-5%.1 Paravalvular leaks are more common with mechanical valves and mitral valves than with bioprosthetic and aortic valves. The incidence of paravalvular leaks after mitral valve replacement is approximately 12.5%. Various factors are thought to contribute to the development of paravalvular leaks shortly after surgery - an incomplete seal between the sewing ring and valve annulus, annular calcification and infection.2 Size of the paravalvular leak usually determines the clinical presentation of the leak. Smaller leaks (6 mm), are associated with significant regurgitation leading to heart failure.3

The major indications for treatment of paravalvular leaks include severe symptoms with valve regurgitation and persistent, severe hemolysis requiring multiple periodic blood transfusions. The current gold standard for treatment of paravalvular leaks is surgery with either replacement or resuturing of the original prosthesis. Reoperation is associated with higher mortality and morbidity than the initial operation, with reported mortality as high as 13%, 15% and 37% following first, second and third procedures, respectively.4 The operative mortality after paravalvular leak surgery is around 7%, and the perioperative stroke rate of 5% with a 10-year Kaplan-Meier survival of 30%. In elderly patients with comorbidities, and in patients with multiple prior chest surgeries, however, the risks of reoperation frequently prohibit surgery. In these patients, percutaneous closure offers an attractive alternative for the treatment of paravalvular leaks, as it is considerably less invasive than surgery and might be associated with fewer risks to the patient.57

How to Cite: 1. Guthikonda S, Zoghbi WA, Kleiman NS, Little SH. Percutaneous Repair of Mitral Paravalvular Regurgitation. Methodist DeBakey Cardiovascular Journal. 2008;4(3):26-28. DOI: http://doi.org/10.14797/mdcvj.135
Published on 01 Jan 2008.
Peer Reviewed

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