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Transcatheter intervention comparable to surgical intervention for paravalvular leak closure
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At 1 year, patients who underwent transcatheter intervention for paravalvular leak closure had similar clinical outcomes as those who underwent surgical intervention, according to published data.
In a retrospective cohort study, 56 patients underwent transcatheter intervention and 58 underwent surgical intervention for moderate or greater paravalvular leak closure from 2007 to 2016.
At baseline, in the transcatheter intervention group, active endocarditis was less common (0% vs. 25.9%; P < .001) and patients were older (71 years vs. 62 years; P = .01) than in the surgical intervention group.
Paravalvular leak locations were mitral in 69 patients (60.5%), aortic in 39 patients (34.2%) and pulmonary in six patients (5.3%).
The primary endpoint, defined as a composite of death, reintervention for paravalvular leak closure or readmission for congestive HF-related symptoms at 1 year, did not differ between groups (transcatheter intervention, 33.9%; surgical intervention, 39.7%; P = .526). Results also indicated no difference in 1-year survival (transcatheter intervention, 83.9%; surgical intervention, 75.9%; P = .283).
However, postoperative stay in the transcatheter intervention group was shorter than in the surgical intervention group (4 days vs. 8 days; P < .001), as was ICU stay (0 days vs. 3 days; P < .001). Readmission rate at 30 days was also lower in the transcatheter intervention group (8.9% vs. 25.9%; P = .017).
“With improving techniques and experience, [transcatheter intervention] may be a better initial treatment strategy, as resource use and perioperative morbidity are significantly improved,” the researchers wrote. “Larger, multicenter studies are needed to detect differences between [transcatheter intervention] and [surgical intervention] and to better define the clinical indications for each.” – by Melissa Foster
Disclosure: Several researchers report financial ties to Apica, Direct Flow Medical, Edwards Lifesciences, Medtronic, Sorin and St. Jude Medical.
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