Correlation between structural changes and acute thrombogenicity in transcatheter pericardium valves after crimping and balloon deployment

Bourget, Jean-Michel; Zegdi, Rachid; Jing, Lin; Wawryko, P.; Merhi, Yahye; Convelbo, Channing; Mao, Jifu; Fu, Ying; Xu, Tongpeng; Merkel, N.; Wang, L.; Germain, Lucie; Zhang, Z.; Guidoin, Robert

doi:10.1016/j.morpho.2016.06.003

Cited by 30 publications

(12 citation statements)

References 35 publications

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“…Moreover, lesions at the surface layer may predispose to subclinical valve thrombosis and subsequently SVD (figure 1). 48 Because of the elliptical shape of the native aortic annulus and the frequent presence of bulky calcifications, the deployment of the stent is often non-circular and irregular 49. A non-circular cross-sectional shape and/or a local deformation of the stent may increase mechanical stress on valve leaflets and may cause abnormal transvalvular and post-valvular flow patterns with areas of high flow shear stress and flow stasis 50 51…”

Section: Durability Of Transcatheter Bioprosthesesmentioning

confidence: 99%

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Bioprosthetic aortic valve durability in the era of transcatheter aortic valve implantation

Salaün

Clavel

Rodés‐Cabau

et al. 2018

Heart

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The main limitation of bioprosthetic valves is their limited durability, which exposes the patient to the risk of aortic valve reintervention. Transcatheter aortic valve implantation (TAVI) is considered a reasonable alternative to surgical aortic valve replacement (SAVR) in patients with intermediate or high surgical risk. TAVI is now rapidly expanding towards the lower risk populations. Although the results of midterm durability of the transcatheter bioprostheses are encouraging, their long-term durability remains largely unknown. The objective of this review article is to present the definition, mechanisms, incidence, outcome and management of structural valve deterioration of aortic bioprostheses with specific emphasis on TAVI. The structural valve deterioration can be categorised into three stages: stage 1: morphological abnormalities (fibrocalcific remodelling and tear) of bioprosthesis valve leaflets without hemodynamic valve deterioration; stage 2: morphological abnormalities and moderate hemodynamic deterioration (increase in gradient and/or new onset of transvalvular regurgitation); and stage 3: morphological abnormalities and severe hemodynamic deterioration. Several specifics inherent to the TAVI including valve oversizing, manipulation, delivery, positioning and deployment may cause injuries to the valve leaflets and increase leaflet mechanical stress, which may limit the long-term durability of transcatheter bioprostheses. The selection of the type of aortic valve replacement and bioprosthesis should thus take into account the ratio between the demonstrated durability of the bioprostheses versus the life expectancy of the patient. Pending the publication of robust data on long-term durability of transcatheter bioprostheses, it appears reasonable to select SAVR with a bioprosthesis model that has well-established long-term durability in patients with low surgical risk and long life expectancy.

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Section: Durability Of Transcatheter Bioprosthesesmentioning

confidence: 99%

“…Moreover, lesions at the surface layer may predispose to subclinical valve thrombosis and subsequently SVD (figure 1). 48 …”

Section: Durability Of Transcatheter Bioprosthesesmentioning

confidence: 99%

Bioprosthetic aortic valve durability in the era of transcatheter aortic valve implantation

Salaün

Clavel

Rodés‐Cabau

et al. 2018

Heart

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“…In vitro studies simulating crimped leaflets have demonstrated increased platelet and red blood cell clusters adhering to the surface of crimped, damaged fibrous layers. 23 The leaflet surface becomes a nidus for de novo thrombus formation, as has been observed on explanted transcatheter valves. 24 The leaflet material could also contribute to its thrombogenicity, albeit to a lesser extent than the factors just discussed.…”

Section: Hemodynamic Flow Alterationmentioning

confidence: 94%

Subclinical Leaflet Thrombosis in Transcatheter Aortic Valve Replacement Detected by Multidetector Computed Tomography　― A Review of Current Evidence ―

Rashid

Brown

McCormick

et al. 2018

Circ J

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Subclinical leaflet thrombosis (SLT) following transcatheter aortic valve replacement (TAVR) has been increasingly recognized. SLT has the hallmark features of hypo-attenuated leaflet thickening (HALT) on multidetector computed tomography (MDCT), which may result in hypoattenuation affecting motion (HAM). The actual prevalence of this condition is uncertain, with limited observational registries. SLT has caught the attention of the cardiovascular community because of concerns regarding its clinical sequelae, specifically the potential increased incidence of cerebrovascular events. There are available, albeit sparse, data to suggest that when left untreated, SLT may lead to valve deterioration with potential hemodynamic compromise and potentially clinically overt prostheses thrombosis. Some clinicians have opted to treat patients with SLT with anticoagulation. Although anticoagulation may be a rational treatment option, little data exist on the safety and efficacy of this treatment. This is particularly important considering TAVR patients also have higher bleeding risk than the standard population. In this review, we aim to summarize the current evidence on SLT, explore its pathophysiological mechanism, discuss the current treatment options and future trials that may clarify the optimal antithrombotic strategies of SLT.

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“…Bovine pericardium represents the material of choice to serve as leaflets but this material is fragile and mishandling might lead to dramatic consequences. The complete innocuousness of handling at implantation has not been reached as crimping and balloon inflation cause various degrees of injury [4]. These can impair the physical characteristics and aggravate the thrombogenicity.…”

Section: Commentarymentioning

confidence: 99%

“…This is why we have undertaken this series of in vitro testing regarding the platelet uptake [4]. The thrombi, generally exophytic but occasionally endophytic must be eliminated to prevent any calcification.…”

Section: Injuries At Crimping and Deployment That Cannot Be Repaired mentioning

confidence: 99%

Transcatheter Heart Valve Crimping and Expansion: Commentary

Guidoin¹,

Mao²,

Zegdi³

et al. 2017

J Med Surg Pathol

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Bovine pericardium represents the material of choice to serve as leaflets but this material is fragile and mishandling might lead to dramatic consequences. The complete innocuousness of handling at implantation has not been reached as crimping and balloon inflation cause various degrees of injury. These can impair the physical characteristics and aggravate the thrombogenicity. The design of the device must promote the long-term durability of the pericardium. The role and selection of polyester fabrics as buffer between the metallic frame and the pericardium is likely to prevent major abrasion at implantation and in situ.

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Correlation between structural changes and acute thrombogenicity in transcatheter pericardium valves after crimping and balloon deployment

Cited by 30 publications

References 35 publications

Bioprosthetic aortic valve durability in the era of transcatheter aortic valve implantation

Bioprosthetic aortic valve durability in the era of transcatheter aortic valve implantation

Subclinical Leaflet Thrombosis in Transcatheter Aortic Valve Replacement Detected by Multidetector Computed Tomography　― A Review of Current Evidence ―

Transcatheter Heart Valve Crimping and Expansion: Commentary

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Correlation between structural changes and acute thrombogenicity in transcatheter pericardium valves after crimping and balloon deployment

Cited by 30 publications

References 35 publications

Bioprosthetic aortic valve durability in the era of transcatheter aortic valve implantation

Bioprosthetic aortic valve durability in the era of transcatheter aortic valve implantation

Subclinical Leaflet Thrombosis in Transcatheter Aortic Valve Replacement Detected by Multidetector Computed Tomography ― A Review of Current Evidence ―

Transcatheter Heart Valve Crimping and Expansion: Commentary

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Subclinical Leaflet Thrombosis in Transcatheter Aortic Valve Replacement Detected by Multidetector Computed Tomography　― A Review of Current Evidence ―