Objectives. The purpose of this study was to review the experiences with transcatheter closure of mitral PVL after surgical valve replacement. Background. Transcatheter closure of paravalvular leak (PVL) is an intricate alternative to surgical closure. But it represents one of the most intricate procedures in the field of structural heart interventions, especially for patients with mitral PVL. Methods. From January 2015 through January 2019, 35 patients with mitral PVL after valve replacement underwent transcatheter closure. We reviewed the catheter techniques, perioperative characteristics, and prognosis. The median follow-up was 26 (3–48) months. Results. Acute procedural success was achieved in 33/35 (94.3%) patients. Twenty-five patients had single mitral prosthetic valve replacements; 10 had combined aortic and mitral prosthetic valve replacements previously; 28 had mechanical valves; and 7 had bioprosthetic valves. All percutaneous procedures were performed with local anesthesia except for seven transapical cases with general anesthesia. Multiple approaches were used: transfemoral, transapical, and transseptal via an arteriovenous loop. Multiple devices were deployed. There were no hospital deaths. The procedural time was 67–300 (124 ± 62) minutes. Fluoroscopic time was 17–50 (23.6 ± 12.1) minutes. The hospital stay was 5–17 (8.3 ± 3.2) days. Complications included recurrent hemolysis, residual regurgitation, acute renal insufficiency, and anemia. Twenty-seven (77.1%) patients improved by ≥1 New York Heart Association functional class at the 1-year follow-up. Conclusions. Transcatheter mitral PVL closure requires complex catheter techniques. However, this minimally invasive treatment could provide reliable outcomes and shorter hospital stays in selected patients. This trial is registered with NCT02917980.

中文翻译：

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多种方法经导管封堵二尖瓣旁漏

目标。本研究的目的是回顾手术瓣膜置换术后经导管关闭二尖瓣 PVL 的经验。背景。瓣周漏 (PVL) 的经导管闭合是手术闭合的复杂替代方法。但它代表了结构性心脏干预领域最复杂的程序之一，尤其是对于二尖瓣 PVL 患者。方法。从 2015 年 1 月到 2019 年 1 月，35 例瓣膜置换术后二尖瓣 PVL 患者接受了经导管闭合术。我们回顾了导管技术、围手术期特征和预后。中位随访时间为 26 (3-48) 个月。结果. 33/35 (94.3%) 的患者获得了急性手术成功。25 名患者进行了单瓣二尖瓣置换术；10 人曾合并主动脉瓣和二尖瓣人工瓣置换术；28个有机械阀门；7 人有生物瓣膜。除 7 例经心尖全身麻醉外，所有经皮手术均在局部麻醉下进行。使用了多种方法：经股动脉、经心尖和通过动静脉环的经间隔。部署了多个设备。没有医院死亡。手术时间为 67–300 (124 ± 62) 分钟。透视时间为 17-50 (23.6 ± 12.1) 分钟。住院时间为 5-17 (8.3 ± 3.2) 天。并发症包括反复溶血、残余反流、急性肾功能不全和贫血。二十七 (77.结论。经导管二尖瓣 PVL 闭合需要复杂的导管技术。然而，这种微创治疗可以为选定的患者提供可靠的结果和更短的住院时间。该试验已在 NCT02917980 注册。