Comparison of transcatheter and surgical treatment of paravalvular leak: Results from a 5-year follow-up study
Funding information: Research Fund for the Scientific and Technical Project of Shanghai Municipality, Grant/Award Number: 17411970900; Research Fund for the Scientific and Technical Project of Shanghai Chest Hospital, Grant/Award Number: 20134449
This article was published online on 25 October 2017. An error was subsequently identified in the Author line. This notice is included in the online and print versions to indicate that both have been corrected 21 March 2018.
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.
