Paravalvular leak incidence after mitral surgical replacement ranges from 7% to 17%. Between 1% and 5% of these are clinically significant. Large PVLs can cause important clinical manifestations such as heart failure or haemolysis. Current guidelines consider that surgical reparation is the gold-standard therapy in symptomatic patients with paravalvular leak. However, these recommendations are based in non-randomized observational registries. On the other hand, transcatheter paravalvular leak closure has shown excellent results with a low rate of complications, and nowadays it is considered the first option in selected patients in some experienced centres. In this review, we summarize the clinical manifestations, diagnosis, procedural details, and results of transcatheter mitral PVL closure.

Background: Paravalvular leak occurs in 5–17% of patients following surgical valve replacement, more often in mitral position. The prognosis without treatment is poor. Percutaneous device closure represents an alternative to repeat surgery. The objective of this work is to evaluate the medium and long-term results in the percutaneous closure of PVL in mitral prosthesis. Methods: This observational study is based on a retrospective registry including consecutive mitral PVL cases undergoing percutaneous closure at a single tertiary-care center from April 2010 to December 2020. The safety and efficacy results of the procedure, at 90 days and in the long term, were analyzed. Also, predictors of procedure failure and long-term events were identified. Results: A total of 128 consecutive mitral paravalvular leak closure procedures were included. Technical success was achieved in 115 (89.8%) procedures. The presence of multiple PVLs was the sole factor that independently predicted procedural failure. Median follow-up of our sample was 41.8 months (mean 47.7 ± 35.7 months). Underlying hemolytic anemia as the indication for PVL closure, a recent admission for decompensated HF, and lack of improvement in functional class emerged as consistent predictors of MACE and death during long-term follow-up, while lack of procedural success during the first PVL procedure and chronic kidney disease were also associated with MACE during follow-up. Conclusions: Percutaneous mitral PVL closure displayed high technical and procedural success rates, with an acceptable safety profile, in a high-risk population. Percutaneous mitral PVL closure achieved an improvement in short- and long-term functional class and a reduction of hemolysis in the vast majority of patients. In addition, long-term survival in our study was good, in particular for patients undergoing successful PVL closure procedures.

Introduction and Objectives: Advanced chronic kidney disease (A‐CKD) combined with atrial fibrillation increases the risk of both thrombogenic and bleeding events. Left atrial appendage occlusion (LAAO) may be an alternative to oral anticoagulation to prevent thromboembolic events. We aimed to evaluate the outcomes of LAAO in patients with A‐CKD.Methods: Comparison at long‐term follow‐up of patients diagnosed with and without A‐CKD (eGFR<30 mL/min/1.73 m²) who underwent LAAO between 2009 and May 2022.Results: Five hundred seventy‐three patients were included. Eighty‐one (14%) were diagnosed with A‐CKD. There were no differences in sex, age, and cardiovascular risk factors, except for diabetes which was more frequent in patients with A‐CKD. The control group had higher rates of stroke, both ischemic and hemorrhagic. There were no differences in the CHA₂DS₂‐VASc score, although A‐CKD patients had a higher bleeding risk according to the HASBLED scale. Global procedural success was 99.1%. At follow‐up, there were no differences in stroke rate: at 1‐year (HR: 1.22, IC‐95%: 0.14–10.42, p = 0.861); at 5‐years (HR: 0.60, IC‐95%: 0.08–4.58, p = 0.594). Although bleeding events were higher in the A‐CKD group, no differences were found in major bleeding (defined BARC ≥ 3) at 1‐year (HR: 1.34, IC‐95%: 0.63–2.88, p = 0.464) or at 5‐years follow‐up (HR: 1.30, IC‐95%: 0.69–2.48, p = 0.434). Mortality rate at 5 years was higher in the A‐CKD patients (HR: 1.84, IC‐95%: 1.18–2.87, p = 0.012).Conclusions: LAAO is an effective and safe treatment in A‐CKD patients to prevent ischemic events and bleeding. This strategy could be an alternative to oral anticoagulation in this high‐risk group of patients.