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  • Title: Comparison of transcatheter and surgical treatment of paravalvular leak: Results from a 5-year follow-up study.
    Author: Zhang Y, Pan X, Qu X, Wang C, Huang E, Ma L, Wu W, Fang W.
    Journal: Catheter Cardiovasc Interv; 2019 Aug 01; 94(2):E88-E95. PubMed ID: 29068133.
    Abstract:
    OBJECTIVE: This study aimed to compare the efficacy and safety of two different treatments of paravalvular leak (PVL). BACKGROUND: PVL is a common complication after surgical valve replacement. Re-operation is associated with high mortality, morbidity, and risk of re-leak. Catheter-based repair has emerged as a promising new therapy. METHODS AND RESULTS: Eighty-seven consecutive patients with symptomatic PVL received either transcatheter (n = 46) or surgical (n = 41) treatment at Shanghai Chest Hospital between January 2009 and December 2015.The procedural and clinical success rates were similar between the transcatheter group and the surgical group (82.6 vs. 90.2%; P = 0.30; and 69.5 vs. 73.0%; P = 0.71, respectively). There were fewer in-hospital total major adverse events in the transcatheter group (56.09 vs. 17.39%; P < 0.001), and transcatheter repair was more cost-effective, with fewer blood transfusions, shorter procedure durations, shorter hospital stays, and less expenditure. However, there were six cases of hemolysis aggravation in the transcatheter group (13.04%). The 5-year overall survival rates after transcatheter and surgical repair were 74.39 and 71.95% (P = 0.45), respectively, and the cardiac-related survival rates were 84.08 and 74.72% (P = 0.19), respectively. CONCLUSION: Transcatheter and surgical repairs are both effective treatments for selected patients with PVL. And, transcatheter closure seems to be safer and more cost-effective. Nonetheless, this new treatment may be risky for post-procedure hemolysis when unsuitable devices are used.
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