Transcatheter Closure of Paravalvular Leaks: Efficacy, Techniques, and Outcomes From a Single-Center Prospective Study Publisher Pubmed



Khalilipur E ; Firouzi A ; Elahifar A ; Moayerifar M ; Abdi S ; Salekdeh M S ; Sadeghipour P ; Dabbaghi M ; Jafari M ; Kia A Z ; Sawaya F ; Gholipour M
Source: Catheterization and Cardiovascular Interventions Published:2026

Abstract

Background: Paravalvular leak (PVL) is a complication after prosthetic valve implantation, leading to issues like hemolysis and heart failure. While redo surgery is the standard treatment, it poses significant risks for high-risk patients. Transcatheter PVL closure has become a less invasive option, with improved efficacy from advanced imaging and device technologies. Aims: This study aims to evaluate the safety, efficacy, and technical strategies of transcatheter PVL closure, including novel approaches like the reverse loop and arteriovenous (AV) rail techniques in a prospective single-center cohort. Methods: Twenty-eight high-risk patients (mean age 57.2 ± 10.1 years) with significant aortic or mitral PVLs underwent transcatheter closure. Procedures were guided by multimodal imaging, assessing technical, procedural, and clinical success rates, along with 6-month outcomes in NYHA functional class and echocardiographic parameters. Results: Out of 28 procedures, 27 were technically successful (96.4%), with clinical success achieved in 92.9% of patients. Most procedures used transfemoral access, treating aortic PVLs retrogradely and mitral PVLs through various routes. Advanced techniques like reverse loop (n = 4) and AV rail (n = 3) were utilized in complex cases. NYHA functional class improved significantly (p < 0.001), with no significant change in left ventricular ejection fraction. One patient required redo surgery, and one died from sepsis. Conclusion: Transcatheter PVL closure is a safe and effective alternative to redo surgery for selected high-risk patients. Advanced imaging and access techniques enhance procedural success, particularly in complex mitral PVLs. Further multicenter studies with long-term follow-up are needed to confirm these results and refine technique selection. © 2026 Wiley Periodicals LLC.