Long-term outcomes of percutaneous paravalvular regurgitation closure after transcatheter aortic valve replacement: A multicenter experience

Francesco Saia, Claudia Martinez, Sameer Gafoor, Vikas Singh, Cristina Ciuca, Ilona Hofmann, Cinzia Marrozzini, John Tan, John Webb, Horst Sievert, Antonio Marzocchi, William W. O'Neill

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Objectives This study sought to evaluate acute and long-term outcomes of percutaneous paravalvular regurgitation (PVR) closure after transcatheter aortic valve replacement (TAVR). Background Severe symptomatic PVR is a predictor of all-cause mortality after TAVR. The current use of devices for transcatheter closure of PVR has been adapted from other indications without known long-term outcomes. Methods The study population consisted of a series of cases pooled together from an international multicenter experience. Patients underwent transcatheter implantation of a closure device for the treatment of clinically relevant PVR after TAVR with balloon-expandable or self-expandable prostheses. Procedural success was defined by successful deployment of a device with immediate reduction of PVR to a final grade ≤2 as assessed by echocardiography. Results Twenty-seven procedures were performed in 24 patients with clinically relevant PVR after the index TAVR procedure (54.2% Edwards Sapien [Edwards Lifesciences, Irvine, California], 45.8% CoreValve [Medtronic, Minneapolis, Minnesota]). The study population included 75% men with a mean age of 80.6 ± 7.1 years and mean Society of Thoracic Surgeon score of 6.6%. The most frequently used device was Amplatzer Vascular Plug (St. Jude Medical, St. Paul, Minnesota) in 80% of the cases. Overall, 88.9% (24 of 27) of the procedures were technically successful and the results assessed by echocardiography were durable. However, cumulative survival rates at 1, 6, and 12 months were 83.3%, 66.7%, and 61.5%. Most of the deaths (8 of 11) were due to noncardiac causes. Conclusions Transcatheter closure of PVR after TAVR can be performed with a high procedural success rate; however, the long-term mortality remains high mainly due to noncardiac causes.

Original languageEnglish (US)
Pages (from-to)681-688
Number of pages8
JournalJACC: Cardiovascular Interventions
Volume8
Issue number5
DOIs
StatePublished - Apr 27 2015

Fingerprint

Equipment and Supplies
Echocardiography
Mortality
Population
Prostheses and Implants
Blood Vessels
Thorax
Survival Rate
Transcatheter Aortic Valve Replacement
Therapeutics
Surgeons

Keywords

  • closure devices
  • paravalvular regurgitation
  • transcatheter aortic valve
  • vascular plug

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Long-term outcomes of percutaneous paravalvular regurgitation closure after transcatheter aortic valve replacement : A multicenter experience. / Saia, Francesco; Martinez, Claudia; Gafoor, Sameer; Singh, Vikas; Ciuca, Cristina; Hofmann, Ilona; Marrozzini, Cinzia; Tan, John; Webb, John; Sievert, Horst; Marzocchi, Antonio; O'Neill, William W.

In: JACC: Cardiovascular Interventions, Vol. 8, No. 5, 27.04.2015, p. 681-688.

Research output: Contribution to journalArticle

Saia, F, Martinez, C, Gafoor, S, Singh, V, Ciuca, C, Hofmann, I, Marrozzini, C, Tan, J, Webb, J, Sievert, H, Marzocchi, A & O'Neill, WW 2015, 'Long-term outcomes of percutaneous paravalvular regurgitation closure after transcatheter aortic valve replacement: A multicenter experience', JACC: Cardiovascular Interventions, vol. 8, no. 5, pp. 681-688. https://doi.org/10.1016/j.jcin.2014.11.022
Saia, Francesco ; Martinez, Claudia ; Gafoor, Sameer ; Singh, Vikas ; Ciuca, Cristina ; Hofmann, Ilona ; Marrozzini, Cinzia ; Tan, John ; Webb, John ; Sievert, Horst ; Marzocchi, Antonio ; O'Neill, William W. / Long-term outcomes of percutaneous paravalvular regurgitation closure after transcatheter aortic valve replacement : A multicenter experience. In: JACC: Cardiovascular Interventions. 2015 ; Vol. 8, No. 5. pp. 681-688.
@article{7790562793f14fa2bc90b766028acd50,
title = "Long-term outcomes of percutaneous paravalvular regurgitation closure after transcatheter aortic valve replacement: A multicenter experience",
abstract = "Objectives This study sought to evaluate acute and long-term outcomes of percutaneous paravalvular regurgitation (PVR) closure after transcatheter aortic valve replacement (TAVR). Background Severe symptomatic PVR is a predictor of all-cause mortality after TAVR. The current use of devices for transcatheter closure of PVR has been adapted from other indications without known long-term outcomes. Methods The study population consisted of a series of cases pooled together from an international multicenter experience. Patients underwent transcatheter implantation of a closure device for the treatment of clinically relevant PVR after TAVR with balloon-expandable or self-expandable prostheses. Procedural success was defined by successful deployment of a device with immediate reduction of PVR to a final grade ≤2 as assessed by echocardiography. Results Twenty-seven procedures were performed in 24 patients with clinically relevant PVR after the index TAVR procedure (54.2{\%} Edwards Sapien [Edwards Lifesciences, Irvine, California], 45.8{\%} CoreValve [Medtronic, Minneapolis, Minnesota]). The study population included 75{\%} men with a mean age of 80.6 ± 7.1 years and mean Society of Thoracic Surgeon score of 6.6{\%}. The most frequently used device was Amplatzer Vascular Plug (St. Jude Medical, St. Paul, Minnesota) in 80{\%} of the cases. Overall, 88.9{\%} (24 of 27) of the procedures were technically successful and the results assessed by echocardiography were durable. However, cumulative survival rates at 1, 6, and 12 months were 83.3{\%}, 66.7{\%}, and 61.5{\%}. Most of the deaths (8 of 11) were due to noncardiac causes. Conclusions Transcatheter closure of PVR after TAVR can be performed with a high procedural success rate; however, the long-term mortality remains high mainly due to noncardiac causes.",
keywords = "closure devices, paravalvular regurgitation, transcatheter aortic valve, vascular plug",
author = "Francesco Saia and Claudia Martinez and Sameer Gafoor and Vikas Singh and Cristina Ciuca and Ilona Hofmann and Cinzia Marrozzini and John Tan and John Webb and Horst Sievert and Antonio Marzocchi and O'Neill, {William W.}",
year = "2015",
month = "4",
day = "27",
doi = "10.1016/j.jcin.2014.11.022",
language = "English (US)",
volume = "8",
pages = "681--688",
journal = "JACC: Cardiovascular Interventions",
issn = "1936-8798",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Long-term outcomes of percutaneous paravalvular regurgitation closure after transcatheter aortic valve replacement

T2 - A multicenter experience

AU - Saia, Francesco

AU - Martinez, Claudia

AU - Gafoor, Sameer

AU - Singh, Vikas

AU - Ciuca, Cristina

AU - Hofmann, Ilona

AU - Marrozzini, Cinzia

AU - Tan, John

AU - Webb, John

AU - Sievert, Horst

AU - Marzocchi, Antonio

AU - O'Neill, William W.

PY - 2015/4/27

Y1 - 2015/4/27

N2 - Objectives This study sought to evaluate acute and long-term outcomes of percutaneous paravalvular regurgitation (PVR) closure after transcatheter aortic valve replacement (TAVR). Background Severe symptomatic PVR is a predictor of all-cause mortality after TAVR. The current use of devices for transcatheter closure of PVR has been adapted from other indications without known long-term outcomes. Methods The study population consisted of a series of cases pooled together from an international multicenter experience. Patients underwent transcatheter implantation of a closure device for the treatment of clinically relevant PVR after TAVR with balloon-expandable or self-expandable prostheses. Procedural success was defined by successful deployment of a device with immediate reduction of PVR to a final grade ≤2 as assessed by echocardiography. Results Twenty-seven procedures were performed in 24 patients with clinically relevant PVR after the index TAVR procedure (54.2% Edwards Sapien [Edwards Lifesciences, Irvine, California], 45.8% CoreValve [Medtronic, Minneapolis, Minnesota]). The study population included 75% men with a mean age of 80.6 ± 7.1 years and mean Society of Thoracic Surgeon score of 6.6%. The most frequently used device was Amplatzer Vascular Plug (St. Jude Medical, St. Paul, Minnesota) in 80% of the cases. Overall, 88.9% (24 of 27) of the procedures were technically successful and the results assessed by echocardiography were durable. However, cumulative survival rates at 1, 6, and 12 months were 83.3%, 66.7%, and 61.5%. Most of the deaths (8 of 11) were due to noncardiac causes. Conclusions Transcatheter closure of PVR after TAVR can be performed with a high procedural success rate; however, the long-term mortality remains high mainly due to noncardiac causes.

AB - Objectives This study sought to evaluate acute and long-term outcomes of percutaneous paravalvular regurgitation (PVR) closure after transcatheter aortic valve replacement (TAVR). Background Severe symptomatic PVR is a predictor of all-cause mortality after TAVR. The current use of devices for transcatheter closure of PVR has been adapted from other indications without known long-term outcomes. Methods The study population consisted of a series of cases pooled together from an international multicenter experience. Patients underwent transcatheter implantation of a closure device for the treatment of clinically relevant PVR after TAVR with balloon-expandable or self-expandable prostheses. Procedural success was defined by successful deployment of a device with immediate reduction of PVR to a final grade ≤2 as assessed by echocardiography. Results Twenty-seven procedures were performed in 24 patients with clinically relevant PVR after the index TAVR procedure (54.2% Edwards Sapien [Edwards Lifesciences, Irvine, California], 45.8% CoreValve [Medtronic, Minneapolis, Minnesota]). The study population included 75% men with a mean age of 80.6 ± 7.1 years and mean Society of Thoracic Surgeon score of 6.6%. The most frequently used device was Amplatzer Vascular Plug (St. Jude Medical, St. Paul, Minnesota) in 80% of the cases. Overall, 88.9% (24 of 27) of the procedures were technically successful and the results assessed by echocardiography were durable. However, cumulative survival rates at 1, 6, and 12 months were 83.3%, 66.7%, and 61.5%. Most of the deaths (8 of 11) were due to noncardiac causes. Conclusions Transcatheter closure of PVR after TAVR can be performed with a high procedural success rate; however, the long-term mortality remains high mainly due to noncardiac causes.

KW - closure devices

KW - paravalvular regurgitation

KW - transcatheter aortic valve

KW - vascular plug

UR - http://www.scopus.com/inward/record.url?scp=84929170719&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84929170719&partnerID=8YFLogxK

U2 - 10.1016/j.jcin.2014.11.022

DO - 10.1016/j.jcin.2014.11.022

M3 - Article

C2 - 25946440

AN - SCOPUS:84929170719

VL - 8

SP - 681

EP - 688

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

SN - 1936-8798

IS - 5

ER -