Paravalvular leaks: short and long-term outcomes of surgical versus percutaneous closure

Abstract Introduction Paravalvular leaks (PVL) appear in 5–17% of patients who undergo surgical valve replacement, causing heart failure (HF), haemolytic anaemia, or both in 2–5% of cases. Surgical intervention (SI) is the first line treatment, although transcatheter intervention (TI) is gaining ground as an alternative. However, there are no randomized studies comparing both techniques. Purpose The aim of this study is to compare the short and long-term outcomes in patients with symptomatic PVL undergoing SI or TI. Methods We conducted a retrospective analysis of all patients who underwent SI or TI for PVL between 2004 and 2020 in our institution. The primary endpoint (PE) was the composite of cardiovascular mortality, readmission for HF and reintervention for PVL up to 24 months after the procedure. The secondary endpoints were admission length, technical and procedural success, and rate of complications. The definition of technical success was the correct placement of the device with no impaired function of the valve prosthesis and with ≤ grade II residual regurgitation. Procedural success was defined when there was technical success with no presentation of intervention-related complications. Results Picture 1 provides information about the clinical and procedural characteristics, initial outcome and outcome during follow-up. A total 85 procedures, 39 transcatheter (45.9%) and 46 surgical (54.1%), were performed on 67 patients. The patients who underwent TI were older (67.5 versus 61.4 years; p=0.03) had a worse functional class (NYHA III-IV 100% versus 80%; p=0.02), a lower frequency of previous endocarditis (22.2% versus 52.2%; p=0.03) and higher surgical risk (EuroScore 18.7 versus 10.4 and EuroScore II 8.6 versus 5.6; both p=0.001). The hospital stay was significantly shorter for TI (10.2 versus 30.4 days; p=0.009). Additionally, although without statistical significance, there was a lower frequency of complications (41% versus 58.7; p=0.16) and less technical success (69.2% versus 86.7%; p=0.052). There were no differences between procedure success (61.5% versus 71.1%, p=0.49). Regarding PE, at 24 months there were no differences in event-free survival (TI 55.9% versus SI 64.1%; Log-Rank p=0.8) (Picture 2). Conclusion The main finding of our study was the absence of significant differences in the short and long-term outcomes (composite of cardiovascular mortality, readmission for HF and reintervention) between surgical versus percutaneous closure.