For patients with symptomatic paravalvular prosthetic regurgitation, the traditional therapy has been open surgical repair. However, the operative risk of these patients is frequently increased because of extensive morbidity and the need for reoperation. Moreover, technical or anatomic factors that could have led to the development of these paravalvular defects often persist, and may lead to suboptimal outcomes with repeat open surgery. In an effort to overcome these challenges, percutaneous repair of paravalvular prosthetic regurgitation has rapidly emerged as a relatively less invasive therapy. Early feasibility studies have demonstrated acute procedural success in >80% of treated cases, with acceptable short-term risks.The procedure is generally reserved for symptomatic patients without active endocarditis, but there are no firm anatomic criteria for percutaneous repair. Treated defects have involved a variety of biological and mechanical valve prostheses in different anatomic locations. The most commonly used devices for the procedure are Amplatzer~R occluders (AGA Medical, Plymouth, MN) in off-label fashion.
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