Key result
Transcatheter PVL closure offers a highly effective, lower-risk alternative to surgery for significant leaks.
Why the study?
Surgical reoperation for clinically relevant paravalvular leak carries high mortality and morbidity risks, while transcatheter closure has emerged as an effective alternative requiring specialized techniques and advanced imaging.
Transcatheter paravalvular leak closure is a highly effective, albeit complex, alternative to high-risk surgical reoperation for clinically relevant PVLs.
Supports transcatheter PVL closure at experienced centers for select cases; leaves open need for RCTs to confirm superiority over surgery.
Paravalvular leak (PVL) is a well-known complication of valve replacement, occurring in up to 10% of aortic and 17% of mitral prosthetic valves. Although many leaks are small and clinically insignificant, ≈1% to 5% of cases are associated with clinically relevant complications, such as heart failure symptoms and hemolytic anemia. Surgical reoperation is currently considered the first-line option; however, it encompasses high mortality and morbidity risks. In the past years, transcatheter PVL closure has proven to be highly effective when performed in experienced centers. Transcatheter PVL closure requires advanced imaging modalities, specialized materials, and techniques, reflecting the high complexity of the procedure. We review the complex nature of PVL, including its diagnostic workup and the available transcatheter treatment strategies, with a special focus on the treatment of mitral and aortic PVL using plugging devices.
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Ruberti et al. (2026) studied this question. Transcatheter PVL closure is highly effective and less risky than surgery for clinically significant leaks in aortic and mitral prosthetic valves at experienced centers.
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