Conventional surgery and transcatheter closure via surgical transapical approach for paravalvular leak repair in high-risk patients: results from a single-centre experience

Maurizio Taramasso, Francesco Maisano, Azeem Latib, Paolo Denti, Andrea Guidotti, Alessandro Sticchi, Vasileios Panoulas, Gennaro Giustino, Alberto Pozzoli, Nicola Buzzatti, Linda Cota, Michele De Bonis, Matteo Montorfano, Alessandro Castiglioni, Andrea Blasio, Giovanni La Canna, Antonio Colombo, Ottavio Alfieri

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Paravalvular leaks (PVL) occur in up to 17% of all surgically implanted prosthetic valves. Re-operation is associated with high morbidity and mortality. Transcatheter closure via a surgical transapical approach (TAp) is an emerging alternative for selected high-risk patients with PVL. The aim of this study was to compare the in-hospital outcomes of patients who underwent surgery and TA-closure for PVL in our single-centre experience.

METHODS: From October 2000 to June 2013, 139 patients with PVL were treated in our Institution. All the TA procedures were performed under general anaesthesia in a hybrid operative room: in all but one case an Amplatzer Vascular Plug III device was utilized.

RESULTS: Hundred and thirty-nine patients with PVL were treated: 122 patients (87.3%) underwent surgical treatment (68% mitral PVL; 32% aortic PVL) and 17 patients (12.2%) underwent a transcatheter closure via a surgical TAp approach (all the patients had mitral PVL; one case had combined mitral and aortic PVLs); in 35% of surgical patients and in 47% of TAp patients, multiple PVLs were present. The mean age was 62.5 ± 11 years; the Logistic EuroScore was 15.4 ± 3. Most of the patients were in New York Heart Association (NYHA) functional class III-IV (57%). Symptomatic haemolysis was present in 35% of the patients, and it was particularly frequent in the TAp (70%). Many patients had >1 previous cardiac operation (46% overall and 82% of TAp patients were at their second of re-operation). Acute procedural success was 98%. In-hospital mortality was 9.3%; no in-hospital deaths occurred in patients treated through a TAp approach. All the patients had less than moderate residual valve regurgitation after the procedure. Surgical treatment was identified as a risk factor for in-hospital death at univariate analysis (OR: 8, 95% CI: 1.8-13; P = 0.05). Overall actuarial survival at follow-up was 39.8 ± 7% at 12 years and it was reduced in patients who had >1 cardiac re-operation (42 ± 8 vs. 63 ± 6% at 9 years; P = 0.009).

CONCLUSIONS: A transcatheter closure via a surgical TAp approach appears to be a safe and effective therapeutic option in selected high-risk patients with PVL and is associated with a lower hospital mortality than surgical treatment, in spite of higher predicted risk. Long-term survival remains suboptimal in these challenging patients.

Original languageEnglish
Pages (from-to)1161-1167
Number of pages7
JournalEuropean Heart Journal Cardiovascular Imaging
Volume15
Issue number10
DOIs
Publication statusPublished - Oct 1 2014

Fingerprint

Hospital Mortality
Survival
Therapeutics
Hemolysis
General Anesthesia
Blood Vessels
Morbidity
Equipment and Supplies
Mortality

Keywords

  • High risk
  • Percutaneous paravalvular leaks closure
  • Re-operative surgery

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Conventional surgery and transcatheter closure via surgical transapical approach for paravalvular leak repair in high-risk patients : results from a single-centre experience. / Taramasso, Maurizio; Maisano, Francesco; Latib, Azeem; Denti, Paolo; Guidotti, Andrea; Sticchi, Alessandro; Panoulas, Vasileios; Giustino, Gennaro; Pozzoli, Alberto; Buzzatti, Nicola; Cota, Linda; De Bonis, Michele; Montorfano, Matteo; Castiglioni, Alessandro; Blasio, Andrea; La Canna, Giovanni; Colombo, Antonio; Alfieri, Ottavio.

In: European Heart Journal Cardiovascular Imaging, Vol. 15, No. 10, 01.10.2014, p. 1161-1167.

Research output: Contribution to journalArticle

Taramasso, M, Maisano, F, Latib, A, Denti, P, Guidotti, A, Sticchi, A, Panoulas, V, Giustino, G, Pozzoli, A, Buzzatti, N, Cota, L, De Bonis, M, Montorfano, M, Castiglioni, A, Blasio, A, La Canna, G, Colombo, A & Alfieri, O 2014, 'Conventional surgery and transcatheter closure via surgical transapical approach for paravalvular leak repair in high-risk patients: results from a single-centre experience', European Heart Journal Cardiovascular Imaging, vol. 15, no. 10, pp. 1161-1167. https://doi.org/10.1093/ehjci/jeu105
Taramasso, Maurizio ; Maisano, Francesco ; Latib, Azeem ; Denti, Paolo ; Guidotti, Andrea ; Sticchi, Alessandro ; Panoulas, Vasileios ; Giustino, Gennaro ; Pozzoli, Alberto ; Buzzatti, Nicola ; Cota, Linda ; De Bonis, Michele ; Montorfano, Matteo ; Castiglioni, Alessandro ; Blasio, Andrea ; La Canna, Giovanni ; Colombo, Antonio ; Alfieri, Ottavio. / Conventional surgery and transcatheter closure via surgical transapical approach for paravalvular leak repair in high-risk patients : results from a single-centre experience. In: European Heart Journal Cardiovascular Imaging. 2014 ; Vol. 15, No. 10. pp. 1161-1167.
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abstract = "OBJECTIVES: Paravalvular leaks (PVL) occur in up to 17{\%} of all surgically implanted prosthetic valves. Re-operation is associated with high morbidity and mortality. Transcatheter closure via a surgical transapical approach (TAp) is an emerging alternative for selected high-risk patients with PVL. The aim of this study was to compare the in-hospital outcomes of patients who underwent surgery and TA-closure for PVL in our single-centre experience.METHODS: From October 2000 to June 2013, 139 patients with PVL were treated in our Institution. All the TA procedures were performed under general anaesthesia in a hybrid operative room: in all but one case an Amplatzer Vascular Plug III device was utilized.RESULTS: Hundred and thirty-nine patients with PVL were treated: 122 patients (87.3{\%}) underwent surgical treatment (68{\%} mitral PVL; 32{\%} aortic PVL) and 17 patients (12.2{\%}) underwent a transcatheter closure via a surgical TAp approach (all the patients had mitral PVL; one case had combined mitral and aortic PVLs); in 35{\%} of surgical patients and in 47{\%} of TAp patients, multiple PVLs were present. The mean age was 62.5 ± 11 years; the Logistic EuroScore was 15.4 ± 3. Most of the patients were in New York Heart Association (NYHA) functional class III-IV (57{\%}). Symptomatic haemolysis was present in 35{\%} of the patients, and it was particularly frequent in the TAp (70{\%}). Many patients had >1 previous cardiac operation (46{\%} overall and 82{\%} of TAp patients were at their second of re-operation). Acute procedural success was 98{\%}. In-hospital mortality was 9.3{\%}; no in-hospital deaths occurred in patients treated through a TAp approach. All the patients had less than moderate residual valve regurgitation after the procedure. Surgical treatment was identified as a risk factor for in-hospital death at univariate analysis (OR: 8, 95{\%} CI: 1.8-13; P = 0.05). Overall actuarial survival at follow-up was 39.8 ± 7{\%} at 12 years and it was reduced in patients who had >1 cardiac re-operation (42 ± 8 vs. 63 ± 6{\%} at 9 years; P = 0.009).CONCLUSIONS: A transcatheter closure via a surgical TAp approach appears to be a safe and effective therapeutic option in selected high-risk patients with PVL and is associated with a lower hospital mortality than surgical treatment, in spite of higher predicted risk. Long-term survival remains suboptimal in these challenging patients.",
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TY - JOUR

T1 - Conventional surgery and transcatheter closure via surgical transapical approach for paravalvular leak repair in high-risk patients

T2 - results from a single-centre experience

AU - Taramasso, Maurizio

AU - Maisano, Francesco

AU - Latib, Azeem

AU - Denti, Paolo

AU - Guidotti, Andrea

AU - Sticchi, Alessandro

AU - Panoulas, Vasileios

AU - Giustino, Gennaro

AU - Pozzoli, Alberto

AU - Buzzatti, Nicola

AU - Cota, Linda

AU - De Bonis, Michele

AU - Montorfano, Matteo

AU - Castiglioni, Alessandro

AU - Blasio, Andrea

AU - La Canna, Giovanni

AU - Colombo, Antonio

AU - Alfieri, Ottavio

PY - 2014/10/1

Y1 - 2014/10/1

N2 - OBJECTIVES: Paravalvular leaks (PVL) occur in up to 17% of all surgically implanted prosthetic valves. Re-operation is associated with high morbidity and mortality. Transcatheter closure via a surgical transapical approach (TAp) is an emerging alternative for selected high-risk patients with PVL. The aim of this study was to compare the in-hospital outcomes of patients who underwent surgery and TA-closure for PVL in our single-centre experience.METHODS: From October 2000 to June 2013, 139 patients with PVL were treated in our Institution. All the TA procedures were performed under general anaesthesia in a hybrid operative room: in all but one case an Amplatzer Vascular Plug III device was utilized.RESULTS: Hundred and thirty-nine patients with PVL were treated: 122 patients (87.3%) underwent surgical treatment (68% mitral PVL; 32% aortic PVL) and 17 patients (12.2%) underwent a transcatheter closure via a surgical TAp approach (all the patients had mitral PVL; one case had combined mitral and aortic PVLs); in 35% of surgical patients and in 47% of TAp patients, multiple PVLs were present. The mean age was 62.5 ± 11 years; the Logistic EuroScore was 15.4 ± 3. Most of the patients were in New York Heart Association (NYHA) functional class III-IV (57%). Symptomatic haemolysis was present in 35% of the patients, and it was particularly frequent in the TAp (70%). Many patients had >1 previous cardiac operation (46% overall and 82% of TAp patients were at their second of re-operation). Acute procedural success was 98%. In-hospital mortality was 9.3%; no in-hospital deaths occurred in patients treated through a TAp approach. All the patients had less than moderate residual valve regurgitation after the procedure. Surgical treatment was identified as a risk factor for in-hospital death at univariate analysis (OR: 8, 95% CI: 1.8-13; P = 0.05). Overall actuarial survival at follow-up was 39.8 ± 7% at 12 years and it was reduced in patients who had >1 cardiac re-operation (42 ± 8 vs. 63 ± 6% at 9 years; P = 0.009).CONCLUSIONS: A transcatheter closure via a surgical TAp approach appears to be a safe and effective therapeutic option in selected high-risk patients with PVL and is associated with a lower hospital mortality than surgical treatment, in spite of higher predicted risk. Long-term survival remains suboptimal in these challenging patients.

AB - OBJECTIVES: Paravalvular leaks (PVL) occur in up to 17% of all surgically implanted prosthetic valves. Re-operation is associated with high morbidity and mortality. Transcatheter closure via a surgical transapical approach (TAp) is an emerging alternative for selected high-risk patients with PVL. The aim of this study was to compare the in-hospital outcomes of patients who underwent surgery and TA-closure for PVL in our single-centre experience.METHODS: From October 2000 to June 2013, 139 patients with PVL were treated in our Institution. All the TA procedures were performed under general anaesthesia in a hybrid operative room: in all but one case an Amplatzer Vascular Plug III device was utilized.RESULTS: Hundred and thirty-nine patients with PVL were treated: 122 patients (87.3%) underwent surgical treatment (68% mitral PVL; 32% aortic PVL) and 17 patients (12.2%) underwent a transcatheter closure via a surgical TAp approach (all the patients had mitral PVL; one case had combined mitral and aortic PVLs); in 35% of surgical patients and in 47% of TAp patients, multiple PVLs were present. The mean age was 62.5 ± 11 years; the Logistic EuroScore was 15.4 ± 3. Most of the patients were in New York Heart Association (NYHA) functional class III-IV (57%). Symptomatic haemolysis was present in 35% of the patients, and it was particularly frequent in the TAp (70%). Many patients had >1 previous cardiac operation (46% overall and 82% of TAp patients were at their second of re-operation). Acute procedural success was 98%. In-hospital mortality was 9.3%; no in-hospital deaths occurred in patients treated through a TAp approach. All the patients had less than moderate residual valve regurgitation after the procedure. Surgical treatment was identified as a risk factor for in-hospital death at univariate analysis (OR: 8, 95% CI: 1.8-13; P = 0.05). Overall actuarial survival at follow-up was 39.8 ± 7% at 12 years and it was reduced in patients who had >1 cardiac re-operation (42 ± 8 vs. 63 ± 6% at 9 years; P = 0.009).CONCLUSIONS: A transcatheter closure via a surgical TAp approach appears to be a safe and effective therapeutic option in selected high-risk patients with PVL and is associated with a lower hospital mortality than surgical treatment, in spite of higher predicted risk. Long-term survival remains suboptimal in these challenging patients.

KW - High risk

KW - Percutaneous paravalvular leaks closure

KW - Re-operative surgery

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