The interventional cardiology team at the Department of Internal Medicine at the American University of Beirut Medical Center (AUBMC) performed on March 14, 2017 he first percutaneous paravalvular leak (PVL) closure with a vascular plug in Lebanon. This novel procedure addresses patients with significant regurgitation accompanied by symptoms of congestive heart failure and/or hemolysis. It is an alternative treatment option for severely symptomatic, high-surgical risk patients with PVL.
The procedure was performed by Assistant Professor of Medicine in the Department of Internal Medicine, Division of Cardiology , Dr. Fadi Sawaya and Deputy Executive Vice President for Medical Affairs and Dean of Faculty of Medicine and Founding Director of the Heart and Vascular Clinical Center of Excellence, Dr. Ziyad Ghazzal from the Interventional Cardiology team and Assistant Professor, Dr. Hussain Isma’eel from the cardiac imaging team on a 77 year old patient who had severe aortic regurgitation (AR) and would have otherwise needed redo surgery.
Paravalvular leak (PVL) is a complication related to both surgical and trans-catheter valve replacement or implantation when there is backflow around a prosthetic valve. It can lead to hemolysis, heart failure and increased risk of infectious endocarditis. As the mechanism of leaks is not well understood, the alignment between sewing ring and annulus may be incomplete because of significant annular calcification. The tissue around valves can weaken as a result of chronic infection. Even the sutures themselves may not allow significant apposition of the valve with the annulus.
In many patients, reoperation is associated with very high risk and often portends a worse prognosis and is less likely to be successful. Therefore, alternative, less invasive and percutaneous methods using trans-catheter closure have been designed.
“Transcatheter repair of paravalvular leaks represents a new treatment option for patients who are often too frail for repeat surgery,” explained Assistant Professor of Medicine, Division of Cardiology, Dr. Sawaya. “We, at AUBMC, perform all PVL interventions with transesophageal echocardiography guidance often with 3D characterization of leak size and course. As to success rates, they are elevated with pre- procedural TEE and CT and when the procedure is performed by an experienced operator. Outcomes show acceptable rates of technical and clinical success, with lower procedural morbidity than reoperation,” he added.
This first-of-its-kind procedure is unique since it represents an alternative to open heart surgery and the complications that accompany it and allows early discharge from the hospital. Performed around the world in designated medical centers, the percutaneous paravalvular leak closure with a vascular plug is a new, advanced procedure at AUBMC and is yet another proof of the medical center achieving its 2020 Vision by being a leading medical center in Lebanon and the region.