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Percutaneous closure of prosthetic paravalvular leaks – Should it be considered the first therapeutic option?
Encerramento percutâneo de leaks periprotésicos – deve ser considerada como a primeira opção terapêutica?
Marco Costa
Serviço de Cardiologia, Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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"tienePdf" => "pt" "tieneTextoCompleto" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "495" "paginaFinal" => "497" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Percutaneous closure of prosthetic paravalvular leaks – should it be considered the first therapeutic option?" ] ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 958 "Ancho" => 2447 "Tamanyo" => 223436 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Exemplos de dispositivos para encerramento percutâneo de PVL</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">1) Amplatzer Vascular Plug II; 2) Amplatzer Vascular Plug III; 3) Amplatzer Vascular Plug IV; 4) Amplatzer Duct Occluder; 5) Amplatzer Muscular VSD Occluder; 6) Amplatzer Septal Occluder; 7) Occlutech PLD (forma quadrangular); 8) Occlutech PLD (forma retangular).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marco Costa" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Marco" "apellidos" => "Costa" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204917301630" "doi" => "10.1016/j.repce.2017.06.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917301630?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117303876?idApp=UINPBA00004E" "url" => "/08702551/0000003600000078/v1_201707241250/S0870255117303876/v1_201707241250/pt/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2174204917302027" "issn" => "21742049" "doi" => "10.1016/j.repce.2016.10.023" "estado" => "S300" "fechaPublicacion" => "2017-07-01" "aid" => "1022" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2017;36:499-508" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2547 "formatos" => array:3 [ "EPUB" => 187 "HTML" => 1998 "PDF" => 362 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "The relationship between erythrocyte membrane fatty acid levels and cardiac autonomic function in obese children" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "499" "paginaFinal" => "508" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "A relação entre os níveis dos ácidos gordos da membrana eritrocitária e as funções autonómicas cardíacas nas crianças obesas" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3073 "Ancho" => 3335 "Tamanyo" => 556122 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Scatterplots of correlation analysis between parameters of heart rate variability and variables affecting them in the obese group. LF: low-frequency component; SD: standard deviation; TG: triglycerides.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gulgun Mustafa, Fidanci Muzaffer Kursat, Tas Ahmet, Genc Fatih Alparslan, Gunes Omer, Erdem Sertoglu, Sarı Erkan, Yesilkaya Ediz, Turker Turker, Kılıc Ayhan" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Gulgun" "apellidos" => "Mustafa" ] 1 => array:2 [ "nombre" => "Fidanci Muzaffer" "apellidos" => "Kursat" ] 2 => array:2 [ "nombre" => "Tas" "apellidos" => "Ahmet" ] 3 => array:2 [ "nombre" => "Genc Fatih" "apellidos" => "Alparslan" ] 4 => array:2 [ "nombre" => "Gunes" "apellidos" => "Omer" ] 5 => array:2 [ "nombre" => "Erdem" "apellidos" => "Sertoglu" ] 6 => array:2 [ "nombre" => "Sarı" "apellidos" => "Erkan" ] 7 => array:2 [ "nombre" => "Yesilkaya" "apellidos" => "Ediz" ] 8 => array:2 [ "nombre" => "Turker" "apellidos" => "Turker" ] 9 => array:2 [ "nombre" => "Kılıc" "apellidos" => "Ayhan" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255117304134" "doi" => "10.1016/j.repc.2016.10.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117304134?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302027?idApp=UINPBA00004E" "url" => "/21742049/0000003600000078/v1_201707290050/S2174204917302027/v1_201707290050/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2174204917302015" "issn" => "21742049" "doi" => "10.1016/j.repce.2016.12.019" "estado" => "S300" "fechaPublicacion" => "2017-07-01" "aid" => "1018" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2017;36:489-94" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2060 "formatos" => array:3 [ "EPUB" => 168 "HTML" => 1462 "PDF" => 430 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Percutaneous closure of periprosthetic paravalvular leaks: A viable alternative to surgery?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "489" "paginaFinal" => "494" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Encerramento percutâneo de regurgitações periprotésicas: uma alternativa viável à cirurgia?" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 967 "Ancho" => 1333 "Tamanyo" => 76120 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Study group profile. Eighteen patients were referred for percutaneous PVL closure at our center. Sixteen patients underwent a single procedure and two a second procedure, in a total of 20 procedures. Fifteen procedures were successful: 14 PVL closures in mitral prostheses (eight in biological and six in mechanical mitral valves) and one in a biological aortic prosthesis. PVL: paravalvular leak.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana Isabel Azevedo, Pedro Braga, Alberto Rodrigues, Lino Santos, Bruno Melica, José Ribeiro, Francisco Sampaio, Ricardo Fontes-Carvalho, Marlene Fonseca, Adelaide Dias, Vasco Gama Ribeiro" "autores" => array:11 [ 0 => array:2 [ "nombre" => "Ana Isabel" "apellidos" => "Azevedo" ] 1 => array:2 [ "nombre" => "Pedro" "apellidos" => "Braga" ] 2 => array:2 [ "nombre" => "Alberto" "apellidos" => "Rodrigues" ] 3 => array:2 [ "nombre" => "Lino" "apellidos" => "Santos" ] 4 => array:2 [ "nombre" => "Bruno" "apellidos" => "Melica" ] 5 => array:2 [ "nombre" => "José" "apellidos" => "Ribeiro" ] 6 => array:2 [ "nombre" => "Francisco" "apellidos" => "Sampaio" ] 7 => array:2 [ "nombre" => "Ricardo" "apellidos" => "Fontes-Carvalho" ] 8 => array:2 [ "nombre" => "Marlene" "apellidos" => "Fonseca" ] 9 => array:2 [ "nombre" => "Adelaide" "apellidos" => "Dias" ] 10 => array:2 [ "nombre" => "Vasco" "apellidos" => "Gama Ribeiro" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255117303864" "doi" => "10.1016/j.repc.2016.12.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117303864?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302015?idApp=UINPBA00004E" "url" => "/21742049/0000003600000078/v1_201707290050/S2174204917302015/v1_201707290050/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Percutaneous closure of prosthetic paravalvular leaks – Should it be considered the first therapeutic option?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "495" "paginaFinal" => "497" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Marco Costa" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Marco" "apellidos" => "Costa" "email" => array:1 [ 0 => "marcocostacard@sapo.pt" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço de Cardiologia, Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Encerramento percutâneo de <span class="elsevierStyleItalic">leaks</span> periprotésicos – deve ser considerada como a primeira opção terapêutica?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 958 "Ancho" => 2447 "Tamanyo" => 223436 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Examples of devices used for percutaneous paravalvular leak closure: (1) Amplatzer Vascular Plug II; (2) Amplatzer Vascular Plug III; (3) Amplatzer Vascular Plug IV; (4) Amplatzer Duct Occluder; (5) Amplatzer Muscular VSD Occluder; (6) Amplatzer Septal Occluder; (7) Occlutech PLD (square); (8) Occlutech PLD (rectangular).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Paravalvular leak (PVL) is one of the most common complications of surgical implantation of mechanical or biological valve prostheses and, more recently, with percutaneous valve replacement. Its incidence ranges, according to the series, between 2 and 10% for aortic valves and 7 and 17% for mitral valves.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although most patients with PVL have few or no symptoms and are accordingly treated conservatively, some leaks can lead to an unfavorable clinical outcome, including heart failure (HF), hemolytic anemia or death.</p><p id="par0015" class="elsevierStylePara elsevierViewall">It is now accepted that PVLs should be closed if associated with hemolytic anemia, congestive HF, worsening left ventricular function or progressive left ventricular dilatation.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The severity of the regurgitant jet(s) is not as important as the clinical repercussions of regurgitation. For this reason, even PVLs with mild or moderate regurgitation on echocardiographic criteria should be treated if they are associated with hemolysis, HF, or progressive left ventricular dilatation.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Following transcatheter valve replacement, intermediate-risk patients with mild PVL usually have a benign clinical course, but mortality is higher in patients at higher risk and with comorbidities at two-year follow-up.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">4–6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Medical treatment is merely palliative, and until recently the only option for patients with clinical indication for PVL closure was surgical correction. Various closure techniques have been described, including direct suturing and placement of autologous tissue or patches, but all these options have high failure rates, ranging from 12 to 35%. In-hospital mortality is also high, particularly in cases of reintervention, such as the 12-37% seen in a series of 618 surgical reinterventions by Echevarria et al.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The first percutaneous PVL closure was reported by Hourihan et al.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">8</span></a> in 1992, and since then several small series have been published. In a recent meta-analysis including 362 patients, the procedural success rate was 76.5%, and procedural success was accompanied by lower cardiac mortality during follow-up (odds ratio [OR]: 0.08, 95% confidence interval [CI]: 0.01-0.9), fewer surgical reinterventions (OR: 0.08, 95% CI: 0.01-0.4) and improvements in HF and hemolytic anemia.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a> The 30-day incidence of major adverse events (death, myocardial infarction, stroke, major bleeding and urgent surgery) is less than 10%, which compares favorably with surgery.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">10</span></a> Embolization of closure devices is a rare complication and very few cases of late embolization have been reported.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Closure of aortic PVLs is usually technically simpler, with only one access route, and echocardiographic support is not as crucial as with the mitral valve, for which various access routes can be used (antegrade transseptal, retrograde transaortic and transapical) and for which the assistance of imaging techniques other than angiography, such as three-dimensional transesophageal echocardiography, is essential. New modalities have recently been developed, integrating images with fusion technology (tomography, angiography and echocardiography), such as Philips Medical Systems’ HeartNavigator and EchoNavigator.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a> Certain locations of mitral PVL, particularly medial or septal, are extremely challenging, for which steerable sheaths such as the Agilis NxT (St. Jude Medical) or an arteriovenous loop may be useful, and in some cases the best option could be a transapical approach.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Another factor that is crucial to success in these procedures is operator experience; complications decrease and success rates rise as the operator gains experience.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">13</span></a> This experience should be concentrated in a reference center and in an operator trained in structural cardiac intervention.</p><p id="par0050" class="elsevierStylePara elsevierViewall">With regard to the devices used for PVL closure, the choice is determined by what is available in a given center and a particular country, and is also influenced by the operator's experience with specific devices in other types of structural intervention. Some case series deal with a single device, as in the series by Cruz-González et al. with the Amplatzer Vascular Plug (AVP) III (St. Jude Medical), in which success rates were over 90%.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a> However, most series are based on more than one device. The most popular is the AVP II (St. Jude Medical), which has been approved by the US Food and Drug Administration.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a> The sizes most often used are between 8 mm and 12 mm for the AVP II, which is round in shape and thus permits the implantation of more than one device. Furthermore, it makes more sense to implant multiple small devices rather than a single large one, since this is more likely to result in complete closure and less likely to interfere with the prosthetic valve.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In cases of PVL following transcatheter aortic valve implantation, the device most often used is the AVP IV, but success rates are lower (around 60%), mainly due to difficulty in cannulating the leak. New devices have recently been developed that are specifically designed for PVLs, such as the Occlutech PLD<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a> (which comes in rectangular and square forms), but their use is currently limited to small series (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The series by Azevedo et al.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">16</span></a> published in this issue of the <span class="elsevierStyleItalic">Journal</span> presents the experience of a single center treating different types of patients with mechanical and biological valves, aortic and mitral PVL, and a variety of devices. The results are generally good and are consistent with larger previously published series. Given the small numbers of patients treated in each Portuguese center, it is important to establish prospective, multicenter national registries that collect information systematically, to shed more light on this therapeutic alternative.</p><p id="par0065" class="elsevierStylePara elsevierViewall">It would be difficult to perform studies specifically designed to provide evidence on which to base future recommendations on this subject, but it is clear that the good results of percutaneous PVL closure compared to the surgical alternative already make it the first-line treatment for clinically relevant PVL.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Costa M. Encerramento percutâneo de <span class="elsevierStyleItalic">leaks</span> periprotésicos – deve ser considerada como a primeira opção terapêutica? Rev Port Cardiol. 2017;36:495–497.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 958 "Ancho" => 2447 "Tamanyo" => 223436 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Examples of devices used for percutaneous paravalvular leak closure: (1) Amplatzer Vascular Plug II; (2) Amplatzer Vascular Plug III; (3) Amplatzer Vascular Plug IV; (4) Amplatzer Duct Occluder; (5) Amplatzer Muscular VSD Occluder; (6) Amplatzer Septal Occluder; (7) Occlutech PLD (square); (8) Occlutech PLD (rectangular).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0085" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K. 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| Year/Month | Html | Total | |
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| 2024 May | 38 | 30 | 68 |
| 2024 April | 41 | 21 | 62 |
| 2024 March | 27 | 23 | 50 |
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| 2023 October | 37 | 22 | 59 |
| 2023 September | 34 | 30 | 64 |
| 2023 August | 41 | 24 | 65 |
| 2023 July | 71 | 10 | 81 |
| 2023 June | 45 | 23 | 68 |
| 2023 May | 54 | 28 | 82 |
| 2023 April | 30 | 13 | 43 |
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| 2022 December | 60 | 24 | 84 |
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| 2021 January | 56 | 13 | 69 |
| 2020 December | 61 | 15 | 76 |
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| 2020 March | 72 | 14 | 86 |
| 2020 February | 121 | 75 | 196 |
| 2020 January | 71 | 12 | 83 |
| 2019 December | 53 | 5 | 58 |
| 2019 November | 50 | 13 | 63 |
| 2019 October | 51 | 6 | 57 |
| 2019 September | 75 | 9 | 84 |
| 2019 August | 40 | 5 | 45 |
| 2019 July | 43 | 15 | 58 |
| 2019 June | 41 | 21 | 62 |
| 2019 May | 37 | 12 | 49 |
| 2019 April | 34 | 13 | 47 |
| 2019 March | 162 | 11 | 173 |
| 2019 February | 95 | 10 | 105 |
| 2019 January | 122 | 12 | 134 |
| 2018 December | 91 | 10 | 101 |
| 2018 November | 168 | 14 | 182 |
| 2018 October | 229 | 16 | 245 |
| 2018 September | 55 | 14 | 69 |
| 2018 August | 43 | 7 | 50 |
| 2018 July | 34 | 6 | 40 |
| 2018 June | 56 | 8 | 64 |
| 2018 May | 57 | 12 | 69 |
| 2018 April | 69 | 8 | 77 |
| 2018 March | 104 | 19 | 123 |
| 2018 February | 61 | 10 | 71 |
| 2018 January | 41 | 9 | 50 |
| 2017 December | 113 | 15 | 128 |
| 2017 November | 71 | 22 | 93 |
| 2017 October | 58 | 33 | 91 |
| 2017 September | 60 | 43 | 103 |
| 2017 August | 103 | 41 | 144 |
| 2017 July | 25 | 15 | 40 |
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