Case Report: Transcatheter closure of paravalvular leak following left ventricular assist device and aortic valve replacement

Background: End-stage dilated cardiomyopathy (DCM) is a common cause of end-stage heart failure, and some patients may eventually require heart transplantation. Such patients often need a left ventricular assist device (LVAD) as a bridge to heart transplantation, and those with severe aortic regurgitation may undergo concurrent aortic valve replacement. Paravalvular leak (PVL) is a complication following valve surgery that can lead to worsening heart failure; however, reports on transcatheter closure of PVL after LVAD implantation are rare. Case summary: ), accompanied by worsening symptoms of heart failure. Due to the extremely high risk of redo surgery (STS score 16.2%), a multidisciplinary team consisting of cardiac surgeons, interventional cardiologists, intensive care physicians, and echocardiographers decided to perform transcatheter closure. The procedure was successfully performed via a retrograde approach through the right femoral artery, guided by fluoroscopy combined with transthoracic echocardiography. A 10 × 8 mm ventricular septal defect occluder was used to successfully seal the leak. Intraoperative angiography and echocardiography confirmed the satisfactory position of the occluder with no residual shunt. At the 2-month and 6-month follow-up visits post-procedure, the patient's cardiac function had improved to NYHA class II, echocardiography showed no residual PVL, and the left ventricular dimensions were slightly reduced compared to previous measurements. Conclusion: This case suggests that transcatheter closure may be a safe and effective treatment option for high-risk patients who develop PVL following LVAD implantation combined with aortic valve replacement, providing a reference for the individualized management of similar complex cases.