Long-term study of patients undergoing transcatheter paravalvular leak closure for hemolysis.

Objectives. Paravalvular leak (PVL) is a complication of valve replacement that may result in hemolytic anemia. This study evaluated the long-term impact of transcatheter PVL closure (TPVLC) on hemolysis markers in affected patients. Methods. This multicenter study included 39 patients who underwent TPVLC for hemolysis from February 2013 to March 2024. Lactate dehydrogenase (LDH), hemoglobin (Hb) and indirect bilirubin were assessed at baseline and at 1, 6, 12, and 24 months. A subgroup of patients who had received preprocedural blood transfusions was also analyzed. Secondary endpoints included procedure-related hemolysis and preprocedural predictors of hemolysis compared with a cohort treated for heart failure. Results. In the overall cohort (n = 39), TPVLC resulted in a significant improvement in hemolysis markers. Indirect bilirubin levels significantly decreased from the first month (P = .001), while LDH levels showed a significant reduction from 6 months onwards (P = .02). Hb levels significantly increased from the first month (P = .009). In transfused patients, both LDH and indirect bilirubin levels significantly decreased from the first month (P = .006 and P = .005, respectively), whereas Hb levels demonstrated a significant increase from 6 months onwards (P = .011). Procedure-related hemolysis occurred in 3 (7.7%) patients. Predictors of hemolysis included mechanical prostheses (P = .008), mitral PVL (P = .002), and chronic kidney disease (P = .001). Conclusions. TPVLC significantly improves hemolysis markers over long-term follow-up.