Youjun Zhang1, Xin Pan1, Xinkai Qu1, Cheng Wang1, Estella Huang2, Lan Ma1, Weihua Wu1, Weiyi Fang1. 1. Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Shanghai, 200030, China. 2. University of Illinois, 808 South Wood Street, Chicago, Illinois, 60612.
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.
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.