Impact of a successful percutaneous mitral paravalvular leak closure on long-term major clinical outcomes.

Background Percutaneous mitral paravalvular leak (PVL) closure techniques are an effective and safe alternative to surgical treatment, but data regarding long-term outcomes are scarce. We aim to describe the impact of successful percutaneous mitral PVL closure on long-term outcomes. Methods All consecutive patients in whom a first-attempt percutaneous mitral PVL closure was performed in a single tertiary center between January 2010 and October 2021 were included. Clinical variables, procedural details and procedural success were collected. Patients were classified based on procedural success, defined as no more than mild residual leak. All-cause mortality was the primary endpoint. Cardiovascular death and heart failure hospitalizations (HFH) were key secondary endpoints. Results Ninety patients (median age 72.5 years [66.0-78.4]; median Euroscore-II 8.2 [5.3-12.46]) were included. Although reduction of at least one degree in PVL severity was achieved in 82 (91.1%), procedural success was achieved in 47 (52.2%). Chronic kidney disease, previous surgery for PVL, and the presence of multiple jets, were independently associated with procedural failure. After a median follow-up of 3.2 (1.2-5.2) years, mortality rate was higher in the procedural failure group (27.3 per 100 patients-years) compared to the group with successful closure (8.2 per 100 patient-years). Procedural failure was associated with all-cause death (adjusted hazard ratio [aHR]:2.59; 95%CI:1.41-4.78), cardiovascular death (aHR:3.53, 95%CI:1.67–7.49) and HFH (aHR:3.27, 95%CI:1.72–6.20). Conclusions A successful reduction in PVL to mild or absent is associated with improved rates of all-cause death, cardiovascular death and HFH.