Percutaneous Treatment of Paravalvular Leaks

Valvular surgery has offered a better survival for patients with valvulopathy. Para-valvular leak (PVL) is a relatively common complication of surgical valve replacement. The incidence is estimated between 5 and 17%. This complication can also occur after percutaneous valve replacement. This partial disinsertion is at the origin of a para-prosthetic leak of variable severity. This disinsertion may be secondary to tissue fragility, significant calcification or secondary to endocarditis. These PVL are a factor of poor prognosis and can lead to severe hemolysis and heart failure. Surgical revision is often at high risk especially in multi-operated patients. The development of percutaneous closure of PVL was encouraged. Nevertheless, percutaneous PVL closures are complex procedures, non-standardized, with little suitable equipment. Medical devices dedicated to the occlusion of vessels or intracardiac shunts are often used in an "off-label" fashion. The objective of this review is to evaluate the current results of percutaneous treatment of PVL and to provide the perspectives.