Expert Review of Cardiovascular Therapy
ISSN: 1477-9072 (Print) 1744-8344 (Online) Journal homepage: http://www.tandfonline.com/loi/ierk20
Paravalvular leak: a commentary Mazen K Khalil & Stamatios Lerakis To cite this article: Mazen K Khalil & Stamatios Lerakis (2014) Paravalvular leak: a commentary, Expert Review of Cardiovascular Therapy, 12:6, 647-648 To link to this article: http://dx.doi.org/10.1586/14779072.2014.916616
Published online: 21 May 2014.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ierk20 Download by: [206.214.3.133]
Date: 05 October 2015, At: 02:06
Letter to the Editor
Paravalvular leak: a commentary Expert Rev. Cardiovasc. Ther. 12(6), 647–648 (2014)
Mazen K Khalil Department of Medicine, Division of Cardiology, Emory University School of Medicine, 1365 Clifton Rd NE, Suite AT-503, Atlanta, GA 30322, USA
Stamatios Lerakis
Downloaded by [206.214.3.133] at 02:06 05 October 2015
Author for correspondence: Department of Medicine, Division of Cardiology, Emory University School of Medicine, 1365 Clifton Rd NE, Suite AT-503, Atlanta, GA 30322, USA [email protected]
informahealthcare.com
Response to: Reed GW, Tuzcu EM, Kapadia SR, Krishnaswamy A. Catheter-based closure of paravalvular leak. Expert. Rev. Cardiovasc. Ther. 12(6), 681–692 (2014).
In the review article by Reed et al. [1], the authors review catheter-based closure techniques of paravalvular leaks (PVLs) as well as the devices used to treat them. The structural heart disease field has witnessed astounding success in percutaneous valve replacements in surgical and non-surgical candidates [2]. However, valve replacements (percutaneous and open) have been plagued with complications such as PVLs due mainly to the sizing of the valve non-invasively (percutaneous valves) and to severe annular calcifications among other causes. PVLs are present more however in percutaneously replaced valves [3]. PVLs have an incidence of 7–17% of mitral and 2–10% of aortic valve replacement. While the majority of PVLs is clinically benign, clinically significant PVLs occur in 1–5% of mitral valve replacements and aortic valve replacements [4]. The assessment of PVLs should include various imaging modalities including Echocardiography, MRI and angiography specifically in cases when there is discrepancy in assessment of severity of PVLs among different modalities [5–7]. The clinical importance of PVLs stems from the fact that they have a deleterious effect on ventricular function and survival; in patients with transcatheter aortic valve replacement, any PVL was shown to lead to increased mortality [2]. Hence, the necessity of timely treatment of PVLs. Given the increased mortality with reoperation to correct PVLs surgically,
10.1586/14779072.2014.916616
structural heart disease specialists improvised percutaneous techniques for PVL closure. Devices designed for treatment of patent ductus arteriosus, atrial or ventricular septal defects served as tools to close PVLs depending on location and size of the PVLs [4]. Currently, all the treatment options are used off-label; however, we predict that there will be a revolution in innovation of better valve designs which will reduce the incidence of PVLs. In addition, devices designed to treat PVLs specifically are expected to appear in the structural cardiology landscape. However, multiple hurdles exist in the road to innovation of devices specifically geared to close PVLs including the ill-defined nature of PVLs anatomy, and the lack of monetary incentives given the limited load of patients [4]. Despite all the difficulties however, the structural heart disease world will not stop to amaze us with exciting new breakthroughs. Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was utilized in the production of this manuscript.
Ó 2014 Informa UK Ltd
ISSN 1477-9072
647
Letter to the Editor
Khalil & Lerakis
A comprehensive review of the literature. J Am Coll Cardiol 2013;61(11):1125-36
References 1.
2.
Kodali SK, Williams MR, Smith CR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 2012;366(18):1686-95 Genereux P, Head SJ, Hahn R, et al. Paravalvular leak after transcatheter aortic valve replacement: the new Achilles’ heel?
4.
McElhinney DB. Will there ever be a food and drug administration-approved device for transcatheter paravalvular leak closure? Circ Cardiovasc Interv 2014;7(1):2-5
5.
Lerakis S, Hayek SS, Douglas PS. Paravalvular aortic leak after transcatheter aortic valve replacement: current knowledge. Circulation 2013;127(3):397-407
6.
Lerakis S, Hayek S, Arepalli CD, et al. Cardiac magnetic resonance for paravalvular
7.
Hayek S, Sawaya F, Oshinski J, Lerakis S. Multiparametric assessment of post-transcatheter aortic valve repacement paravalvular regurgitation grading by transthoracic echocardiography and cardiac magnetic resonance. J Clin Exp Cardiolog 2014;5:291
Downloaded by [206.214.3.133] at 02:06 05 October 2015
3.
Reed GW, Tuzcu EM, Kapadia SR, Krishnaswamy A. Catheter-based closure of paravalvular leak. Expert Rev Cardiovasc Ther 2014;12(6):681-92
leaks in post-transcatheter aortic valve replacement. Circulation 2014;129(14): e430-1
648
Expert Rev. Cardiovasc. Ther. 12(6), (2014)
ISSN: 1477-9072 (Print) 1744-8344 (Online) Journal homepage: http://www.tandfonline.com/loi/ierk20
Paravalvular leak: a commentary Mazen K Khalil & Stamatios Lerakis To cite this article: Mazen K Khalil & Stamatios Lerakis (2014) Paravalvular leak: a commentary, Expert Review of Cardiovascular Therapy, 12:6, 647-648 To link to this article: http://dx.doi.org/10.1586/14779072.2014.916616
Published online: 21 May 2014.
Submit your article to this journal
Article views: 76
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ierk20 Download by: [206.214.3.133]
Date: 05 October 2015, At: 02:06
Letter to the Editor
Paravalvular leak: a commentary Expert Rev. Cardiovasc. Ther. 12(6), 647–648 (2014)
Mazen K Khalil Department of Medicine, Division of Cardiology, Emory University School of Medicine, 1365 Clifton Rd NE, Suite AT-503, Atlanta, GA 30322, USA
Stamatios Lerakis
Downloaded by [206.214.3.133] at 02:06 05 October 2015
Author for correspondence: Department of Medicine, Division of Cardiology, Emory University School of Medicine, 1365 Clifton Rd NE, Suite AT-503, Atlanta, GA 30322, USA [email protected]
informahealthcare.com
Response to: Reed GW, Tuzcu EM, Kapadia SR, Krishnaswamy A. Catheter-based closure of paravalvular leak. Expert. Rev. Cardiovasc. Ther. 12(6), 681–692 (2014).
In the review article by Reed et al. [1], the authors review catheter-based closure techniques of paravalvular leaks (PVLs) as well as the devices used to treat them. The structural heart disease field has witnessed astounding success in percutaneous valve replacements in surgical and non-surgical candidates [2]. However, valve replacements (percutaneous and open) have been plagued with complications such as PVLs due mainly to the sizing of the valve non-invasively (percutaneous valves) and to severe annular calcifications among other causes. PVLs are present more however in percutaneously replaced valves [3]. PVLs have an incidence of 7–17% of mitral and 2–10% of aortic valve replacement. While the majority of PVLs is clinically benign, clinically significant PVLs occur in 1–5% of mitral valve replacements and aortic valve replacements [4]. The assessment of PVLs should include various imaging modalities including Echocardiography, MRI and angiography specifically in cases when there is discrepancy in assessment of severity of PVLs among different modalities [5–7]. The clinical importance of PVLs stems from the fact that they have a deleterious effect on ventricular function and survival; in patients with transcatheter aortic valve replacement, any PVL was shown to lead to increased mortality [2]. Hence, the necessity of timely treatment of PVLs. Given the increased mortality with reoperation to correct PVLs surgically,
10.1586/14779072.2014.916616
structural heart disease specialists improvised percutaneous techniques for PVL closure. Devices designed for treatment of patent ductus arteriosus, atrial or ventricular septal defects served as tools to close PVLs depending on location and size of the PVLs [4]. Currently, all the treatment options are used off-label; however, we predict that there will be a revolution in innovation of better valve designs which will reduce the incidence of PVLs. In addition, devices designed to treat PVLs specifically are expected to appear in the structural cardiology landscape. However, multiple hurdles exist in the road to innovation of devices specifically geared to close PVLs including the ill-defined nature of PVLs anatomy, and the lack of monetary incentives given the limited load of patients [4]. Despite all the difficulties however, the structural heart disease world will not stop to amaze us with exciting new breakthroughs. Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was utilized in the production of this manuscript.
Ó 2014 Informa UK Ltd
ISSN 1477-9072
647
Letter to the Editor
Khalil & Lerakis
A comprehensive review of the literature. J Am Coll Cardiol 2013;61(11):1125-36
References 1.
2.
Kodali SK, Williams MR, Smith CR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 2012;366(18):1686-95 Genereux P, Head SJ, Hahn R, et al. Paravalvular leak after transcatheter aortic valve replacement: the new Achilles’ heel?
4.
McElhinney DB. Will there ever be a food and drug administration-approved device for transcatheter paravalvular leak closure? Circ Cardiovasc Interv 2014;7(1):2-5
5.
Lerakis S, Hayek SS, Douglas PS. Paravalvular aortic leak after transcatheter aortic valve replacement: current knowledge. Circulation 2013;127(3):397-407
6.
Lerakis S, Hayek S, Arepalli CD, et al. Cardiac magnetic resonance for paravalvular
7.
Hayek S, Sawaya F, Oshinski J, Lerakis S. Multiparametric assessment of post-transcatheter aortic valve repacement paravalvular regurgitation grading by transthoracic echocardiography and cardiac magnetic resonance. J Clin Exp Cardiolog 2014;5:291
Downloaded by [206.214.3.133] at 02:06 05 October 2015
3.
Reed GW, Tuzcu EM, Kapadia SR, Krishnaswamy A. Catheter-based closure of paravalvular leak. Expert Rev Cardiovasc Ther 2014;12(6):681-92
leaks in post-transcatheter aortic valve replacement. Circulation 2014;129(14): e430-1
648
Expert Rev. Cardiovasc. Ther. 12(6), (2014)
