Paravalvular leak (PVL) occurs when there is backflow around a prosthetic valve. This can occur through a variety of causes. Paravalvular Leak is accompanied by regurgitation and is often a significant problem for patients with bioprosthetic or mechanical heart valves.1 Often manifesting as heart failure (85 % of all presenting symptoms) and hemolysis (13–47 % of all presenting symptoms and signs),2,3 PVL has a prevalence rate as high as 5–17 % of all mechanical valves.4–6
The mechanism of leaks is not well understood. The alignment between sewing ring and annulus may be incomplete because of significant annular calcification. The tissue around valves can weaken as a result of chronic infection. Even the sutures themselves may not allow significant apposition of the valve with the annulus. All of these factors can lead to significant PVL.
How can PVL be treated? Unfortunately, repeat surgery portends a worse prognosis, with mortality rates for the first redo, second redo or third redo surgery of 13 %, 15 %, and 35 %, respectively2. Each repeat operation is less likely to be successful. Therefore there is ample room for percutaneous approaches.
It is important to select the right patients for PVL closure. Prior to beginning a case, it is important to exclude active infection, valve instability, and/or cardiac thrombus.5 Indications for PVL closure include patients with significant regurgitation accompanied by symptoms of congestive heart failure and/or hemolysis. Important contraindications to PVL closure may include presence of active local or systemic infection, active ischemia, mechanical instability of the prosthetic valve, intracardiac thrombus, and patients with a life expectancy due to comorbidities that is less than 6 months.