Percutaneous paravalvular leak closure for balloon-expandable transcatheter aortic valve replacement: a comparison with surgical aortic valve replacement paravalvular leak closure.

Aims: Paravalvular leak (PVL) is frequently observed after transcatheter aortic valve replacement (TAVR) and is related to increased mortality. Percutaneous PVL closure, which is a viable option for this complication, has been performed following surgical aortic valve replacement (SAVR); however, the experience in TAVR remains limited. We sought to compare this technique between post-TAVR and post-SAVR cases.

Methods And Results: A single-center series of patients consecutively undergoing percutaneous PVL closure was reviewed. Each group had 10 cases and procedural/imaging variables were assessed. Although there was no severe complication during the procedures, procedural success rate was lower in the post-TAVR group (60% vs. 100%; P=.04). There was resistance in all 4 unsuccessful cases, and we were unable to advance the delivery sheath over the wire. Computed tomography revealed that unsuccessful cases had higher calcification volume in the corresponding leaflet (351.4 ± 205.1 mm³ vs. 121.8 ± 111.7 mm³; P=.049). This finding can explain the mechanism of difficulty; the higher volume of calcification increases the resistance while advancing the delivery sheath.

Conclusion: This is the first study revealing the difficulty of percutaneous PVL closure following TAVR compared with SAVR. However, it is a preferred approach in TAVR patients given their high risk for a surgical procedure. Computed tomography assessment of calcification volume provides important information for preprocedural planning.