Ricerc@Sapienza

Paravalvular leak (PVL) is not an unfrequent complication after heart valve replacement procedures. This condition occurs in 2–10 % and 7–17 % of aortic and mitral valve replacements respectively[1–3]. Numerous procedural and patient factors have been associated with PVL development[4]. Although the majority of PVLs are subclinical, about 3 % of patients develop severe heart failure, hemolysis or a combination of both requiring re-intervention[5–7]. Surgical repair is the cornerstone in the treatment of symptomatic PVL. Nevertheless, repeat surgical repair is associated with high mortality and a high risk of re-leakage. Thus, few patients are referred to a second surgical correction. Furthermore, mortality increases progressively with the number of re-operations, up 37 % after the third re-operation[4]. The development of catheter-based treatment for structural heart diseases and the need to reduce morbidity and mortality in the treatment of paravalvular leaks has driven medical professionals along with the medical industry to introduce less invasive treatment—catheter-based PVL closure— into clinical practice[8]. Moreover, transcatheter closure of PVL will become more frequent due to the expanding indication of transcatheter aortic valve replacement (TAVR) to younger and lower-risk patients. Actually patients with a long expectancy of life should not be exposed to the detrimental long term effects of regurgitation consequently increasing the rates of referral to PVL. Due to low significant PVL incidence and paucity of reported data on hard endpoints, up to date there are no large comparison studies between percutaneous and surgical interventions. In order to summarize and analyse available evidence on PVL treatment, we performed a sys-tematic review and meta-analysis of the published studies on surgical and transcatheter treatments of PVL, aiming to compare the safety and effectiveness of these techniques.