Transcatheter Closure or Surgery for Symptomatic Paravalvular Leaks: The Multicenter KISS Registry

GÜNER, Ahmet; KIRMA, Cevat; ERTÜRK, Mehmet; Türkmen, Muhsin; Alıcı, Gökhan; Karabay, Can; UZUN, Fatih; KILIÇGEDİK, Alev; Gündüz, Sabahattin; BABUR GÜLER, Gamze; KALKAN, Ali; Özkan, Birol; Sarı, Münevver; GÜRSOY, Mustafa; Tekin, Meltem; YILDIZ, MUSTAFA; Can, Fatma; Kırali, Kaan; Fedakar, Ali; SARIKAYA, Sabit; Aydın, Ünal; KAHRAMAN, Serkan; İYİGÜN, Taner; AKSÜT, Mehmet; Karpuzoğlu, Eren; Çiloğlu, Koray; Sungur, Mustafa; Tanboğa, İbrahim; Özkan, Mehmet

doi:10.1161/jaha.123.032262

Transcatheter Closure or Surgery for Symptomatic Paravalvular Leaks: The Multicenter KISS Registry

GÜNER A., KIRMA C., ERTÜRK M., Türkmen M., Alıcı G., Karabay C. Y., ...Daha Fazla

Journal of the American Heart Association, cilt.13, sa.1, 2024 (SCI-Expanded, Scopus)

Yayın Türü: Makale / Tam Makale
Cilt numarası: 13 Sayı: 1
Basım Tarihi: 2024
Doi Numarası: 10.1161/jaha.123.032262
Dergi Adı: Journal of the American Heart Association
Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
Anahtar Kelimeler: death, echocardiography, paravalvular leak, surgery, transcatheter closure
Sağlık Bilimleri Üniversitesi Adresli: Evet

Özet

BACKGROUND: The optimal treatment of symptomatic paravalvular leak (PVL) remains controversial between transcatheter closure (TC) and surgery. This large-scale study aimed to retrospectively evaluate the long-term outcomes of the patients who underwent reoperation or TC of PVLs. METHODS AND RESULTS: A total of 335 (men, 209 [62.4%]; mean age, 58.15±12.77 years) patients who underwent treatment of PVL at 3 tertiary centers between January 2002 and December 2021 were included. Echocardiographic features, procedure details, and in-hospital or long-term outcomes were assessed. The primary end point was defined as the all-cause death during follow-up. The regression models were adjusted by applying the inverse probability weighted approach to reduce treatment selection bias. The initial management strategy was TC in 171 (51%) patients and surgery in 164 (49%) cases. Three hundred cases (89.6%) had mitral PVL, and 35 (10.4%) had aortic PVL. The mean left ventricular ejection fraction was 52.03±10.79%. Technical (78.9 versus 76.2%; P=0.549) and procedural success (73.7 versus 65.2%; P=0.093) were similar between both groups. In both univariate and multivariable logistic regression analysis, the in-hospital mortality rate in the overall population was significantly higher (15.9 versus 4.7%) in the surgery group compared with the TC group (unadjusted odds ratio, 3.13 [95% CI, 1.75–5.88]; P=0.001; and adjusted odds ratio (inverse probability-weighted), 4.55 [95% CI, 2.27–10.0]; P<0.001). However, the long-term mortality rate in the overall population did not differ between the surgery group and the TC group (unadjusted hazard ratio [HR], 0.86 [95% CI, 0.59–1.25]; P=0.435; and adjusted HR (inverse probability-weighted), 1.11 [95% CI, 0.67–1.81]; P=0.679). CONCLUSIONS: The current data suggest that percutaneous closure of PVL was associated with lower early and comparable long-term mortality rates compared with surgery.