Successful Percutaneous Mitral Paravalvular Leak Closure Is Associated With Improved Midterm Survival

Background— Percutaneous closure of prosthetic mitral valve paravalvular leak (PVL) has emerged as an alternative to surgical treatment in high-risk patients. Limited data exist on the impact of successful percutaneous PVL closure on midterm outcomes. Methods and Results— We examined consecutive patients who underwent percutaneous mitral PVL closure at Mayo Clinic, Rochester, MN, between January 2006 and January 2017. Procedural success, in-hospital outcomes, and midterm mortality were assessed. A total of 231 patients underwent percutaneous mitral PVL repair at a mean age of 67±12 years. Mean time from mitral valve replacement to percutaneous PVL repair was 1.25 (0.31–7.25) years. One hundred sixty-two patients (70%) had ⩽mild PVL after the procedure. Compared with those who had >mild residual PVL, patients with ⩽mild residual PVL had lower rates of repeat surgical interventions (6% versus 17%; P=0.004) and lower all-cause mortality at 30 days (1% versus 14%; P<0.001) and 1 year (15% versus 39%; P<0.001). Survival at 3 years was 61% in patients who had ⩽mild residual leak and 47% in patients with higher grade of residual PVL (P=0.002). Conclusions— In a large consecutive cohort of patients undergoing percutaneous mitral PVL closure, successful percutaneous reduction of the PVL to mild or less was associated with significant midterm survival benefit.