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Effect of percutaneous paravalvular leak closure on hemolysis.
Catheter Cardiovasc Interv. 2019 03 01; 93(4):713-719.CC

Abstract

OBJECTIVE

To study the effect of percutaneous paravalvular leak closure on hemolysis.

BACKGROUND

Although transcatheter PVL closure reduces heart failure and mortality in symptomatic patients with paravalvular leaks (PVL), little is known about its effect on hemolysis.

METHODS

We retrospectively analyzed patients undergoing transcatheter mitral or aortic PVL closure (January 2005-December 2016) at Mayo Clinic. Patients with anemia or abnormal hemolysis markers (LDH, haptoglobin) were included in the analysis. The primary outcome was defined as hemoglobin increase ≥ 1.5 mg/dL, decrease in LDH above median or improvement in haptoglobin. Univariate and multivariate binary logistic regression modeling were used to determine predictors of successful treatment of hemolysis.

RESULTS

Final study population included 168 patients (130 [77%] mitral, 38 [23%] aortic PVL). Primary outcome occurred in 70 patients (42%). Hemoglobin increased by 1.74 ± 1.69 mg/dL in patients who reached primary outcome. 57/168 (34%) patients required blood transfusion prior to PVL closure compared to 35/168 (21%) postprocedure. The mean reduction in LDH was 403 U/L. Multivariate regression showed that patients with mechanical valves were more likely to have successful outcome (P = 0.044).

CONCLUSION

Percutaneous PVL closure is associated with modest improvement in hemolysis markers, increase in hemoglobin levels and reduction in blood transfusion requirements. This benefit is most significant in patients with mechanical valves.

Authors+Show Affiliations

Department of Cardiovascular Diseases. Mayo Clinic, Rochester, Minnesota.Department of Cardiovascular Diseases. Mayo Clinic, Rochester, Minnesota.Department of Cardiovascular Diseases. Mayo Clinic, Rochester, Minnesota.Department of Cardiovascular Diseases. Mayo Clinic, Rochester, Minnesota.Department of Cardiovascular Diseases. Mayo Clinic, Rochester, Minnesota.Department of Cardiovascular Diseases. Mayo Clinic, Rochester, Minnesota.Department of Cardiovascular Diseases. Mayo Clinic, Rochester, Minnesota.Department of Cardiovascular Diseases. Mayo Clinic, Rochester, Minnesota.Department of Cardiovascular Diseases. Mayo Clinic, Rochester, Minnesota.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30280481

Citation

Panaich, Sidakpal S., et al. "Effect of Percutaneous Paravalvular Leak Closure On Hemolysis." Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, vol. 93, no. 4, 2019, pp. 713-719.
Panaich SS, Maor E, Reddy G, et al. Effect of percutaneous paravalvular leak closure on hemolysis. Catheter Cardiovasc Interv. 2019;93(4):713-719.
Panaich, S. S., Maor, E., Reddy, G., Raphael, C. E., Cabalka, A., Hagler, D. J., Reeder, G. S., Rihal, C. S., & Eleid, M. F. (2019). Effect of percutaneous paravalvular leak closure on hemolysis. Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, 93(4), 713-719. https://doi.org/10.1002/ccd.27917
Panaich SS, et al. Effect of Percutaneous Paravalvular Leak Closure On Hemolysis. Catheter Cardiovasc Interv. 2019 03 1;93(4):713-719. PubMed PMID: 30280481.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of percutaneous paravalvular leak closure on hemolysis. AU - Panaich,Sidakpal S, AU - Maor,Elad, AU - Reddy,Gautam, AU - Raphael,Claire E, AU - Cabalka,Allison, AU - Hagler,Donald J, AU - Reeder,Guy S, AU - Rihal,Charanjit S, AU - Eleid,Mackram F, Y1 - 2018/10/02/ PY - 2018/04/19/received PY - 2018/08/13/revised PY - 2018/09/09/accepted PY - 2018/10/4/pubmed PY - 2020/4/15/medline PY - 2018/10/4/entrez SP - 713 EP - 719 JF - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions JO - Catheter Cardiovasc Interv VL - 93 IS - 4 N2 - OBJECTIVE: To study the effect of percutaneous paravalvular leak closure on hemolysis. BACKGROUND: Although transcatheter PVL closure reduces heart failure and mortality in symptomatic patients with paravalvular leaks (PVL), little is known about its effect on hemolysis. METHODS: We retrospectively analyzed patients undergoing transcatheter mitral or aortic PVL closure (January 2005-December 2016) at Mayo Clinic. Patients with anemia or abnormal hemolysis markers (LDH, haptoglobin) were included in the analysis. The primary outcome was defined as hemoglobin increase ≥ 1.5 mg/dL, decrease in LDH above median or improvement in haptoglobin. Univariate and multivariate binary logistic regression modeling were used to determine predictors of successful treatment of hemolysis. RESULTS: Final study population included 168 patients (130 [77%] mitral, 38 [23%] aortic PVL). Primary outcome occurred in 70 patients (42%). Hemoglobin increased by 1.74 ± 1.69 mg/dL in patients who reached primary outcome. 57/168 (34%) patients required blood transfusion prior to PVL closure compared to 35/168 (21%) postprocedure. The mean reduction in LDH was 403 U/L. Multivariate regression showed that patients with mechanical valves were more likely to have successful outcome (P = 0.044). CONCLUSION: Percutaneous PVL closure is associated with modest improvement in hemolysis markers, increase in hemoglobin levels and reduction in blood transfusion requirements. This benefit is most significant in patients with mechanical valves. SN - 1522-726X UR - https://www.unboundmedicine.com/medline/citation/30280481/Effect_of_percutaneous_paravalvular_leak_closure_on_hemolysis_ L2 - https://doi.org/10.1002/ccd.27917 DB - PRIME DP - Unbound Medicine ER -