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Mackram F Eleid - One of the best experts on this subject based on the ideXlab platform.
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Paravalvular Leak incidence following balloon expandable transcatheter aortic valve replacement according to valve size
Journal of the American College of Cardiology, 2020Co-Authors: Timothy A Joseph, Kevin L Greason, Park P Zheng, Thomas A Foley, Mackram F EleidAbstract:Paravalvular Leak (PVL) is associated with worse outcomes following transcatheter aortic valve replacement (TAVR), rates of PVL have decreased over time with new valve designs, however less is known about the differences in PVL by valve size and how degree of over/under sizing may effect PVL.
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novel antegrade approach to transcatheter aortic valve Paravalvular Leak closure
Journal of Invasive Cardiology, 2019Co-Authors: Abdallah El Sabbagh, Kashish Goel, Mackram F Eleid, Charanjit S Rihal, Gautam Reddy, Mohammed Alhijji, Erin A Fender, Guy S ReederAbstract:: Aortic Paravalvular Leak (PVL) is a known complication of TAVR. PVL closure using vascular occluder devices can be used, particularly in cases with annular calcification preventing adequate seal; however, delivery of equipment can be challenging in TAVR patients due to interaction with the valve stent. We describe a novel antegrade closure approach to treat transcatheter aortic PVL.
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effect of percutaneous Paravalvular Leak closure on hemolysis
Catheterization and Cardiovascular Interventions, 2019Co-Authors: Sidakpal S Panaich, Charanjit S Rihal, Gautam Reddy, Guy S Reeder, Elad Maor, Claire E Raphael, Allison K Cabalka, Donald J Hagler, Mackram F EleidAbstract:OBJECTIVE: To study the effect of percutaneous Paravalvular Leak closure on hemolysis. BACKGROUND: Although transcatheter PVL closure reduces heart failure and mortality in symptomatic patients with Paravalvular Leaks (PVL), little is known about its effect on hemolysis. METHODS: We retrospectively analyzed patients undergoing transcatheter mitral or aortic PVL closure (January 2005-December 2016) at Mayo Clinic. Patients with anemia or abnormal hemolysis markers (LDH, haptoglobin) were included in the analysis. The primary outcome was defined as hemoglobin increase ≥ 1.5 mg/dL, decrease in LDH above median or improvement in haptoglobin. Univariate and multivariate binary logistic regression modeling were used to determine predictors of successful treatment of hemolysis. RESULTS: Final study population included 168 patients (130 [77%] mitral, 38 [23%] aortic PVL). Primary outcome occurred in 70 patients (42%). Hemoglobin increased by 1.74 ± 1.69 mg/dL in patients who reached primary outcome. 57/168 (34%) patients required blood transfusion prior to PVL closure compared to 35/168 (21%) postprocedure. The mean reduction in LDH was 403 U/L. Multivariate regression showed that patients with mechanical valves were more likely to have successful outcome (P = 0.044). CONCLUSION: Percutaneous PVL closure is associated with modest improvement in hemolysis markers, increase in hemoglobin levels and reduction in blood transfusion requirements. This benefit is most significant in patients with mechanical valves.
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Paravalvular Leak in structural heart disease
Current Cardiology Reports, 2018Co-Authors: Kashish Goel, Mackram F EleidAbstract:PURPOSE OF REVIEW: This review will summarize the growing importance of diagnosing and managing Paravalvular Leak associated with surgical and transcatheter valves. RECENT FINDINGS: The burden of Paravalvular Leak is increasing; however, advanced imaging techniques and high degree of clinical suspicion are required for diagnosis and management. The latest data from pivotal clinical trials in the field of transcatheter aortic valve replacement suggest that any Paravalvular Leak greater than mild was associated with worse clinical outcomes. Percutaneous techniques for Paravalvular Leak closure are now the preferred approach, and surgical repair is reserved for contraindications and unsuccessful procedures. Recent data from studies evaluating Paravalvular Leak closure outcomes report a greater than 90% success rate with a significant improvement in patient symptoms. Paravalvular Leak is a growing problem in the structural heart disease arena. Percutaneous closure is successful in more than 90% of the procedures with a low complication rate.
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successful percutaneous mitral Paravalvular Leak closure is associated with improved midterm survival
Circulation-cardiovascular Interventions, 2017Co-Authors: Mackram F Eleid, Guy S Reeder, Allison K Cabalka, Donald J Hagler, Mohamad Alkhouli, Chad J Zack, Mohammad Sarraf, Joseph F Maalouf, Vuyisile T NkomoAbstract:Background— Percutaneous closure of prosthetic mitral valve Paravalvular Leak (PVL) has emerged as an alternative to surgical treatment in high-risk patients. Limited data exist on the impact of successful percutaneous PVL closure on midterm outcomes. Methods and Results— We examined consecutive patients who underwent percutaneous mitral PVL closure at Mayo Clinic, Rochester, MN, between January 2006 and January 2017. Procedural success, in-hospital outcomes, and midterm mortality were assessed. A total of 231 patients underwent percutaneous mitral PVL repair at a mean age of 67±12 years. Mean time from mitral valve replacement to percutaneous PVL repair was 1.25 (0.31–7.25) years. One hundred sixty-two patients (70%) had ≤mild PVL after the procedure. Compared with those who had >mild residual PVL, patients with ≤mild residual PVL had lower rates of repeat surgical interventions (6% versus 17%; P =0.004) and lower all-cause mortality at 30 days (1% versus 14%; P P P =0.002). Conclusions— In a large consecutive cohort of patients undergoing percutaneous mitral PVL closure, successful percutaneous reduction of the PVL to mild or less was associated with significant midterm survival benefit.
Martin B Leon - One of the best experts on this subject based on the ideXlab platform.
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percutaneous Paravalvular Leak closure chasing the chameleon
European Heart Journal, 2016Co-Authors: Fabian Nietlispach, Francesco Maisano, Paul Sorajja, Martin B Leon, Charanjit S Rihal, Ted FeldmanAbstract:Paravalvular Leak (PVL) occurs after both surgical and transcatheter valve replacement/implantation. It can lead to haemolysis, heart failure and may increase the risk of endocarditis. Percutaneous closure has significantly less morbidity than re-operation and is therefore often the therapy of choice. Percutaneous PVL closure can make an important difference for patients and can improve patient prognosis. These procedures can be intricate and larger case series and research is needed to further develop and improve these procedures.
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tct 665 association of Paravalvular Leak after transcatheter aortic valve replacement with readmission for acute heart failure an analysis from partner 1
Journal of the American College of Cardiology, 2016Co-Authors: John Petersen, Susheel Kodali, Rebecca T Hahn, Eugene H Blackstone, Jeevanantham Rajeswaran, David Cohen, Pamela S Douglas, Lars G Svensson, Martin B LeonAbstract:Significant Paravalvular Leak (PVL) following successful transcatheter aortic valve replacement (TAVR) has been associated with increased subsequent mortality. However, the association of significant PVL with readmission for acute heart failure (AHF) has yet to be elucidated. PVL was assessed by
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Paravalvular Leak after transcatheter aortic valve replacement
Minerva Cardioangiologica, 2013Co-Authors: Philippe Genereux, Susheel Kodali, Rebecca T Hahn, Tamim Nazif, Mathew R Williams, Martin B LeonAbstract:: Paravalvular Leak (PVL) is a frequent complication of transcatheter aortic valve replacement (TAVR) that occurs at a much higher rate after TAVR than after conventional surgical aortic valve replacement. Recent reports indicating that PVL may be associated with increased late mortality have raised significant concern. However, the heterogeneity of methods for assessing and quantifying PVL, in addition to lack of consistency in the timing of this assessment, complicate the understanding of its true prevalence, severity, and clinical implications. The following review is an effort to consolidate current knowledge in this area in order to better understand the incidence, progression, and clinical impact of post-TAVR PVL, as well as to focus future research efforts on the assessment, prevention, and treatment of this important complication.
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Paravalvular Leak after transcatheter aortic valve replacement the new achilles heel a comprehensive review of the literature
Journal of the American College of Cardiology, 2013Co-Authors: Philippe Genereux, Nicolas M. Van Mieghem, Susheel Kodali, Rebecca T Hahn, Mathew R Williams, Stuart J Head, Benoit Daneault, Patrick W Serruys, Pieter A Kappetein, Martin B LeonAbstract:Paravalvular Leak (PVL) is a frequent complication of transcatheter aortic valve replacement (TAVR) and is seen at a much higher rate after TAVR than after conventional surgical aortic valve replacement. Recent reports indicating that PVL may be correlated with increased late mortality have raised concerns. However, the heterogeneity of methods for assessing and quantifying PVL, and lack of consistency in the timing of such assessments, is a hindrance to understanding its true prevalence, severity, and effect. This literature review is an effort to consolidate current knowledge in this area to better understand the prevalence, progression, and impact of post-TAVR PVL and to help direct future efforts regarding the assessment, prevention, and treatment of this troublesome complication.
Charanjit S Rihal - One of the best experts on this subject based on the ideXlab platform.
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novel antegrade approach to transcatheter aortic valve Paravalvular Leak closure
Journal of Invasive Cardiology, 2019Co-Authors: Abdallah El Sabbagh, Kashish Goel, Mackram F Eleid, Charanjit S Rihal, Gautam Reddy, Mohammed Alhijji, Erin A Fender, Guy S ReederAbstract:: Aortic Paravalvular Leak (PVL) is a known complication of TAVR. PVL closure using vascular occluder devices can be used, particularly in cases with annular calcification preventing adequate seal; however, delivery of equipment can be challenging in TAVR patients due to interaction with the valve stent. We describe a novel antegrade closure approach to treat transcatheter aortic PVL.
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effect of percutaneous Paravalvular Leak closure on hemolysis
Catheterization and Cardiovascular Interventions, 2019Co-Authors: Sidakpal S Panaich, Charanjit S Rihal, Gautam Reddy, Guy S Reeder, Elad Maor, Claire E Raphael, Allison K Cabalka, Donald J Hagler, Mackram F EleidAbstract:OBJECTIVE: To study the effect of percutaneous Paravalvular Leak closure on hemolysis. BACKGROUND: Although transcatheter PVL closure reduces heart failure and mortality in symptomatic patients with Paravalvular Leaks (PVL), little is known about its effect on hemolysis. METHODS: We retrospectively analyzed patients undergoing transcatheter mitral or aortic PVL closure (January 2005-December 2016) at Mayo Clinic. Patients with anemia or abnormal hemolysis markers (LDH, haptoglobin) were included in the analysis. The primary outcome was defined as hemoglobin increase ≥ 1.5 mg/dL, decrease in LDH above median or improvement in haptoglobin. Univariate and multivariate binary logistic regression modeling were used to determine predictors of successful treatment of hemolysis. RESULTS: Final study population included 168 patients (130 [77%] mitral, 38 [23%] aortic PVL). Primary outcome occurred in 70 patients (42%). Hemoglobin increased by 1.74 ± 1.69 mg/dL in patients who reached primary outcome. 57/168 (34%) patients required blood transfusion prior to PVL closure compared to 35/168 (21%) postprocedure. The mean reduction in LDH was 403 U/L. Multivariate regression showed that patients with mechanical valves were more likely to have successful outcome (P = 0.044). CONCLUSION: Percutaneous PVL closure is associated with modest improvement in hemolysis markers, increase in hemoglobin levels and reduction in blood transfusion requirements. This benefit is most significant in patients with mechanical valves.
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comparative outcome of Paravalvular Leak following surgical versus transcatheter aortic valve replacement
Journal of the American College of Cardiology, 2017Co-Authors: Ratnasari Padang, Mackram F Eleid, Charanjit S Rihal, Kevin L Greason, Christopher G Scott, Patricia A Pellikka, Vuyisile T Nkomo, Sorin V PislaruAbstract:Background: Paravalvular Leak (PVL) negatively impacts outcomes, but a direct comparison of its impact after transcatheter aortic valve replacement (TAVR) versus surgical replacement (SAVR) has not been previously reported. We reviewed our experience to better understand the impact of PVL on
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percutaneous Paravalvular Leak closure chasing the chameleon
European Heart Journal, 2016Co-Authors: Fabian Nietlispach, Francesco Maisano, Paul Sorajja, Martin B Leon, Charanjit S Rihal, Ted FeldmanAbstract:Paravalvular Leak (PVL) occurs after both surgical and transcatheter valve replacement/implantation. It can lead to haemolysis, heart failure and may increase the risk of endocarditis. Percutaneous closure has significantly less morbidity than re-operation and is therefore often the therapy of choice. Percutaneous PVL closure can make an important difference for patients and can improve patient prognosis. These procedures can be intricate and larger case series and research is needed to further develop and improve these procedures.
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techniques and outcomes of percutaneous aortic Paravalvular Leak closure
Jacc-cardiovascular Interventions, 2016Co-Authors: Mohamad Alkhouli, Mackram F Eleid, Guy S Reeder, Elad Maor, Allison K Cabalka, Donald J Hagler, Mohammad Sarraf, Saurabh Sanon, Peter Pollak, Charanjit S RihalAbstract:Abstract Objectives The aim of this study is to provide a summary of the currently applied aortic Paravalvular Leak (PVL) closure techniques and describe the procedural and long-term outcomes in a large consecutive cohort of patients. Background Percutaneous repair has emerged as an effective therapy for patients with PVL. To date, clinical outcome data on percutaneous closure of aortic PVL are limited. Methods All patients who underwent catheter-based treatment of aortic PVL between 2006 and 2015 were identified. Procedural and short-term results were assessed. Patients were contacted for clinical events and symptoms. Results Eighty-six procedures were performed in 80 patients. The mean age was 68 ± 15 years, and 70% were men. The primary indications for PVL closure were symptoms of heart failure, hemolysis, and both in 83%, 5%, and 12%, respectively. Successful device deployment was accomplished in 94 defects (90%). Reduction in PVL to mild or less was achieved in 62% of patients. In-hospital major adverse events occurred in 8% of procedures. Symptomatic improvement at 30 days was achieved in 64% of patients. Patients who had reduction in the PVL grade to mild or less experienced more improvement in New York Heart Association functional class (from 2.93 ± 0.62 to 1.72 ± 0.73) compared with those with mild or greater residual Leak (from 3.03 ± 0.57 to 2.52 ± 0.74) (p Conclusions Percutaneous reduction of aortic PVL is associated with durable symptom relief and lower rates of repeat cardiac surgery. The magnitude of benefit is greatest with PVL reduction to a grade of mild or less. Therefore, attempts should be made to reduce PVL as much as possible.
Ignacio Cruzgonzalez - One of the best experts on this subject based on the ideXlab platform.
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Paravalvular Leak closure with the amplatzer vascular plug iii device immediate and short term results
Revista Espanola De Cardiologia, 2014Co-Authors: Ignacio Cruzgonzalez, Juan Carlos Ramamerchan, Antonio Arribasjimenez, Javier Rodriguezcollado, Javier Martinmoreiras, Manuel Casconbueno, Candido Martin LuengoAbstract:Abstract Introduction and objectives Percutaneous Paravalvular Leak closure is a complex procedure with varying success rates; the lack of closure devices specifically designed for this purpose has hampered this technique. The characteristics of the Amplatzer Vascular Plug III appear to be well suited for Paravalvular Leak closures; however, the available data are limited to case reports or small series of patients. The aim of this study was to analyze the feasibility and efficacy of Paravalvular Leak with this device. Methods The immediate and 90-day safety and efficacy of mitral and aortic Paravalvular Leak closures performed with this device at our hospital were analyzed. Results Percutaneous repair of 34 Paravalvular Leaks (27 mitral, 7 aortic) was attempted in 33 patients. The device was successfully implanted in 93.9% (in 2 patients, a second planned procedure was needed), and successful closure (defined as regurgitation reduction ≥ 1 grade) was achieved in 90.9% of patients. Complications included emergency surgery due to disc interference (n = 1) and blood transfusion (n = 3). There were no reports of procedure-related death, myocardial infarction, or stroke. At 90 days, survival was 100%, and 90.3% of patients showed significant clinical improvement; 4 patients developed vascular complications (pseudoaneurysm). Conclusions Mitral and aortic Paravalvular Leak closure with the Amplatzer Vascular Plug III is feasible and safe, with high clinical and echocardiographic success rates.
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percutaneous retrograde closure of mitral Paravalvular Leak in patients with mechanical aortic valve prostheses
Canadian Journal of Cardiology, 2013Co-Authors: Ignacio Cruzgonzalez, Juan Carlos Ramamerchan, Javier Rodriguezcollado, Javier Martinmoreiras, Antonio ArribasjimenezAbstract:Abstract Mechanical aortic valve prostheses are considered a limiting factor when contemplating percutaneous closure of mitral Paravalvular Leaks using a retrograde approach. However, transfemoral artery access and a retrograde approach have advantages over a trans-septal anterograde approach when the Paravalvular defect is large with a significant gradient or when the defect is medial to the mitral valve. We describe a novel technique of mitral Paravalvular Leak closure in the presence of a mechanical aortic valve prosthesis, which we performed successfully in 3 patients. The technique uses a retrograde approach and arteriovenous wire loop.
Stamatios Lerakis - One of the best experts on this subject based on the ideXlab platform.
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outcomes after Paravalvular Leak closure transcatheter versus surgical approaches
Jacc-cardiovascular Interventions, 2017Co-Authors: John A Wells, Stamatios Lerakis, Jose F Condado, Norihiko Kamioka, Andy Dong, Andrew Ritter, Stephen D Clements, James Stewart, Bradley G Leshnower, Robert A GuytonAbstract:Abstract Objectives The aim of this study was to compare outcomes of transcatheter intervention (TI) versus surgical intervention (SI) for Paravalvular Leak (PVL). Background Data comparing the treatment of PVL with TI and SI are limited. Methods A retrospective cohort study was conducted comparing baseline characteristics, procedural details, and 1-year survival in consecutive patients who underwent TI or SI for moderate or greater PVL from 2007 to 2016. The primary outcome was a composite of death, reintervention for PVL, or readmission for congestive heart failure–related symptoms at 1 year. Results Of 114 patients, 56 underwent TI and 58 underwent SI. PVL locations were mitral, aortic, and pulmonary in 69 (60.5%), 39 (34.2%), and 6 (5.3%) patients, respectively. At baseline, TI patients were older (age 71 vs. 62 years; p = 0.010) and had fewer cases of active endocarditis (0.0% vs. 25.9%, p Conclusions In this study, TI for PVL closure had comparable 1-year clinical outcomes with SI, even after adjusting for differences in baseline characteristics, with less in-hospital morbidity and 30-day rehospitalization. Although further study is needed, these findings support the increased implementation of TI for PVL closure at experienced institutions.
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cmr to stratify post tavr Paravalvular Leak in patients with suboptimal echocardiography
Journal of Cardiovascular Magnetic Resonance, 2014Co-Authors: Gregory R Hartlage, Vasilis C Babaliaros, Vinod H Thourani, Salim Hayek, Patricia Keegan, Stamatios LerakisAbstract:Background Despite extensive pre-procedure evaluation, greater than mild Paravalvular Leak (PVL) occurs in over 10% of patients undergoing transcatheter aortic valve replacement (TAVR) and is associated with worse outcomes. Echocardiography, the standard method of imaging PVL, often has limited utility due to frequently multiple eccentric regurgitant jets. Acoustic shadowing from the valve stent and native aortic valve calcification may lead to further underestimation of PVL. Cardiovascular magnetic resonance (CMR) is considered the gold standard for quantification of valvular regurgitation. We evaluated the utility of CMR to grade PVL severity and predict outcomes in patients with suboptimal echocardiography. Methods Seventeen non-operative post-TAVR patients (NYHA class III-IV; age 84 ± 5 yrs) underwent CMR due to PVL and symptoms out of proportion to echocardiographic findings or suboptimal echocardiographic study. CMR was performed on a Siemens Avanto 1.5 T with velocity phase imaging in the ascending aorta for flow quantification. CMR PVL severity was graded by regurgitant fraction (RF; mild≤20%, moderate 21-39%, severe ≥40%). Short- and intermediate-term follow-up was conducted after CMR. Patients were followed-up for symptoms and a composite outcome of repeat invasive therapy, heart failure hospitalization, or death.
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cardiac mri for evaluation of Paravalvular Leak after transcather aortic valve replacement
Journal of Cardiovascular Magnetic Resonance, 2013Co-Authors: Chesnal D Arepalli, Raul R Blanco, Mihir Kanitkar, John N Oshinski, Vasilis C Babaliaros, Peter C Block, Vinod H Thourani, Robert A Guyton, Arthur E Stillman, Stamatios LerakisAbstract:Background The most common complication of Transcathether Aortic Valve Replacement (TAVR) is aortic regurgitation (AR). Typically, this regurgitation is in the mild range, yet in a smaller subset AR could be in the moderate-severe range. Significant regurgitation is usually due to Paravalvular Leak due to undersizing of the valve or malposition inferiorly into the left ventricular outflow tract or superiorly into the aorta during deployment. Transthoracic Echocardiography (TTE) is first line test for the amount of regurgitation, but can be flawed due to poor acoustic windows and eccentricity of the Paravalvular Leak. Cardiac MRI (CMR) may be used to assess the aortic regurgitation when there is a discrepancy with echocardiography or imaging of the valve is in question.
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repair of prosthetic mitral valve Paravalvular Leak using an off pump transapical approach
The Annals of Thoracic Surgery, 2012Co-Authors: Vinod H Thourani, Chesnal D Arepalli, Peter C Block, Robert A Guyton, Stamatios Lerakis, Colleen M Smith, David Liff, Patrick Willis, Sharon Howell, Bryon J BoultonAbstract:Patients who present with significant Paravalvular regurgitation after mitral valve replacement remain a difficult patient population and high-risk surgical candidates. We present 3 cases of transapical closure of mitral valve Paravalvular Leak (PVL) after mitral valve replacement using Amplatzer closure devices (AGA Medical Corp, Plymouth, MN). All 3 patients experienced decreased regurgitation at the site of the closure as well as symptomatic improvement in their heart failure.
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Utility of Three‐Dimensional Echocardiography in Percutaneous Closure of Paravalvular Leak
Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, 2009Co-Authors: Venkata V. Bavikati, Vasilis Babaliaros, Stamatios LerakisAbstract:The images and videos presented in this case report demonstrate the utility of live three-dimensional (3D) transoesophageal echocardiography (TEE) in guiding the percutaneous closure of Paravalvular Leak (PVL). This method provides high-quality real time assistance for transseptal puncture and deployment of the closure device through the PVL.
