In some patients, operative risk is high, or surgery is not feasible. Nonrandomized studies have dem- onstrated clinical success with percutaneous para- valvular leak closure performed by expert operators underthesupervisionofanMDTataComprehensive Valve Center. Procedural success rates for percuta- neous paravalvular leak closure, typically defined by no more than mild residual regurgitation and the absence of death and major complications, are highly variable. In a large single-center cohort, per- cutaneous repair of 141 paravalvular defects was attempted in 115 patients, with an achieved overall success rate of 77% and a 30-day complication rate In another study of 126 patients who underwent percutaneous paravalvular leak repair, Sorajja and colleagues reported a 3-year survival rate of 64.3%.5 The degree of residual regurgita- tion affects symptom improvement and survival. In a cohort of 231 consecutive patients (2006 2017) who underwent percutaneous mitral paravalvu- lar leak closure, the reduction of paravalvular leak to mild or less was achieved in 70% of patients.7,8 Those patients with mild or less residual paravalvular leak had a survival rate at 3 years of 61%, compared with a rate of 47% in patients with greater degrees of residual paravalvular leak (P=0.002).7,8 Notably, treatment of HF symptoms with paravalvular leak closure is more successful than is treatment of hemolysis. IE should be excluded before attempted paravalvular leak repair. 4. The Valve-In-Valve International Data registry examined outcomes of transcatheter ViV proce- lated regurgitation and 30% had mixed lesions.10 Within 1 month after the ViV procedure, 7.6% of patients died, 1.7% had a major stroke, and 93% of survivors experienced good functional sta- tus. The 1-year survival rate was 83.2%.10 Several systematic reviews have compared outcomes of transcatheter ViV with those of reoperative SAVR. 