More than 200.000 surgical valve replacements are performed in Europe, Middle East and Africa annually.
With the advent of transcatheter technologies, an increasing number of transcatheter aortic valve replacements (TAVR) and valve-in-valve procedures are also being performed.
Paravalvular leak (PVL) is a common complication associated with surgical and transcatheter procedures and is related to a gap between the outer edge of the prosthetic valve and the native annulus. Technical aspects of the index surgery, native tissue properties including the presence of annular calcification, and size mismatch are some of the factors associated with PVLs.
Approximately 1% to 5% of patients undergoing mitral or aortic valve replacements experience PVLs of various severities, ranging from asymptomatic and benign to life-threatening such as hemolysis and heart failure. A repeated surgical procedure is generally related to high perioperative risk. For the high-risk symptomatic PVL patient, catheter closure conversely has significantly less morbidity and is a viable therapeutic alternative strategy to surgical PVL repair, with a high success and low complication rate. Surgical PVL closure also remains an effective treatment for selected cases.
Early recognition and intervention are imperative for appropriate management of PVL, as medical therapy is not effective. Multimodality imaging techniques such as multidimensional CT scan and 3-D TEE are essential for pre-procedural planning and procedural guidance.
A surprising number of different devices and more recently vascular plugs have been used to close aortic or mitral paravalvular leaks. Nevertheless, transcatheter interventions have followed a difficult path of development. The difficulties have been mostly linked to the technical issues, such as visualization of the defect, suboptimal delivery systems, and the lack of dedicated occluders.
A newly PLD was recently CE marked and represent the first transcatheter device specifically designed for the treatment of aortic or mitral PVL of bioprosthetic and mechanical heart valve, been conceived to minimize the technical limitations of previous devices.
The Congress will summarize the most relevant data on the clinical, diagnostic and technical aspects of paravalvular leak treatment and will point out to its limitations and future development. The meeting will cover also surgical aspects of paravalvular leaks, indispensable in understanding of the problem, both in anatomical and clinical terms.
This “Focus Meeting” should be of interest not only for interventional cardiologists dedicated to structural heart disease interventions but also to general cardiologists, cardiac surgeons, internal medicine doctors who often encounter patients with this problem in their clinical practice.
We are very pleased to have several leading experts in the field as presenters and invited guests. We would like to express our sincere thanks for sharing their expertise.
Several presentations will address the use of the available imaging techniques, such as different echo modalities, computed tomography and cardiac nuclear resonance in diagnosing PVL and its quantification, echo guiding during transcatheter PVL closure, and online fusion imaging facilitating proper conduct of the procedure.
Other sessions will provide critical assessment of the currently available equipment, especially the occluders. Special emphasis will be placed on the current techniques used for transapical PVL closure.
The management of paravalvular leaks after transcatheter aortic valve implantation (TAVI) is also addressed, mainly because of similarities of techniques used for PVL closure. We acknowledge however that TAVI-related PVL might reflect the shortcomings of the first-generation TAVI devices and are of different etiology than those related to surgical valves.
We hope that this “Focus on PVL 2019” will contribute to an increase in the understanding of the problem and will foster international collaboration on the development in this area.
ECM: il corso riceve un numero di crediti ECM pari a 7
Durata: 7 ore
A chi è rivolto: Medico Chirurgo specialista in cardiologia; cardiochirurgia; geriatria; medicina interna; medicina generale (medici di famiglia); chirurgia vascolare; malattie infettive; medicina generale (medici di famiglia)
Costo: iscrizione gratuita