Hybrid treatment of aortic and mitral paravalvular leaks: A novel approach

Paravalvular leak (PVL) is a well-recognized complication of prosthetic valve replacement. Peri-prosthetic regurgitation is clinically significant in 1–5% of patients with PVL causing symptoms of congestive heart failure and/or hemolysis. Traditionally, cardiac reoperation and surgical re-replacement of the valve has been the treatment of choice. Reoperations carry higher risks than primary operations and tissue fragility may make successful prosthetic valve re-replacement difficult. Percutaneous closure of PVL is a newer and less invasive technique, gaining popularity especially in high-risk surgical patients. However, the long-term efficacy is unknown, and the technique is limited by the size of the PVL. In the case of multiple PVLs in high-risk patients, another viable alternative is to employ a hybrid strategy. This combination of surgical and percutaneous approaches has not been reported previously. Our report describes the use of a hybrid strategy in the management of multiple PVLs in a high-risk patient. This synergy relies on the Heart Team concept, and may result in improved outcomes with PVLs in high-risk or non-surgical candidates.