Management of paravalvular leaks

Paravalvular leaks occur in 5–17% of patients who underwent aortic or mitral valve implantation. The patients who have a paravalvular leak mostly present with heart failure, hemolytic anaemie, or both.The gold standard for treatment of severe symptomatic paravalvular leaks is reoperation, which is, nevertheless, associated with increased morbidity and is not always successful. Because of frequent patient morbidity and increased risk of reoperation, there is a trend to favor the less invasive approach of initial percutaneous closure without another sternotomy. The percutaneous approach requires implantation of specially dedicated occlusive devices and a choice of three different access sites: antegrade approach through femoral vein with transseptal puncture, retrograde approach through femoral artery and transapical approach. PVL closure is a complex and technically demanding intervention with a success rate between 40% and 90% and an acceptable rate of adverse event. In a group of patients with a high risk of redo surgery the percutaneous closure of PVL can lead to improving symptoms and outcomes.