Moeliker, L. (Laurens) (2021) Transcatheter paravalvular leak closure: an effective alternative to surgical repair with respect to 5-year outcomes. thesis, Medicine.
Full text available on request.Abstract
Introduction Paravalvular leakage (PVL) is a relatively common complication of heart valve replacement, associated with heart failure and increased mortality. Surgical repair has long been the gold standard but transcatheter PVL closure might be a promising alternative, especially in high�risk patients. The current study assessed the safety and efficacy of transcatheter PVL closure compared to surgical repair. Methods This retrospective single-center study included all consecutive patients who underwent either transcatheter PVL closure between January 2013 and December 2020, or surgical repair between March 2015 and December 2020. Primary endpoints were 5-year all-cause mortality and the composite of 5-year cardiovascular mortality and rehospitalization for the underlying condition. Secondary endpoints were technical success and individual patient success at one year according to the PVL Academic Research Consortium. Results Of the 129 patients included, 85 underwent transcatheter repair and 44 went for surgical repair. As compared to surgical repair, patients undergoing transcatheter PVL closure were older (71 vs. 64.5 years; p=<0.01) and more symptomatic (NYHA class III&IV; 76.5% vs. 59.1%; p=0.04). At 5 years, transcatheter PVL closure was comparable to surgery in terms of the primary composite endpoint (HR: 1.20; 95%CI: 0.68-2.13; p=0.54) and all-cause mortality (HR: 1.70; 95%CI: 0.82-3.50; p=0.15). Rates of technical success (92.9% vs. 95.5%; p=0.58) and individual patient success at one year (70.6% vs. 77.3%; p=0.87) were similar between transcatheter PVL closure and surgical repair respectively. Conclusion These findings support the use of transcatheter closure of PVL, especially in high-risk patients. Long-term survival remains temperate in these challenging patients.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Nijenhuis, dr. V.J. and Berg, prof. J.M. ten and Heuvel, dr. A.F.M. van den |
| Faculty: | Medical Sciences |
| Date Deposited: | 05 Jan 2022 11:19 |
| Last Modified: | 05 Jan 2022 11:19 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2946 |
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