Natural history of subclinical leaflet thrombosis affecting motion in bioprosthetic aortic valves

Søndergaard, Lars; Backer, Ole De; Kofoed, Klaus F.; Jilaihawi, Hasan; Fuchs, Andreas; Chakravarty, Tarun; Kashif, Mohammad; Kazuno, Yoshio; Kawamori, Hiroyuki; Maeno, Yoshio; Bieliauskas, Gintautas; Guo, Hongbo; Stone, Gregg W.; Makkar, Raj

doi:10.1093/eurheartj/ehx369

Cited by 185 publications

(113 citation statements)

References 8 publications

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“…After a phase of general debate, the current definition of definite diagnosis of THV‐t is mainly based on the improvement in clinical picture (eg, heart failure symptoms) and in valve hemodynamic (ie, Doppler parameters) after anticoagulation trial . In fact, recent evidence showed that morphologic changes detected by CT (eg, hypo‐attenuation, restricted motion) might regress spontaneously even without anticoagulation . Hence, a purely morphological definition of THV‐t based on CT scan signs might generate false positives of uncertain clinical significance .…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic features of post−transcatheter aortic valve implantation thrombosis and endocarditis

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Echocardiographic features of post−transcatheter aortic valve implantation thrombosis and endocarditis

et al. 2017

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“…Subclinical leaflet thrombosis is a common finding on MDCT 35. Hypoattenuated leaflet thickening (HALT) and hypoattenuation affecting motion are two stages of the same phenomenon, with leaflet thickening affecting leaflet motion at a more advanced stage.…”

Section: Leaflet Thrombosismentioning

confidence: 99%

Antithrombotic therapy in patients undergoing transcatheter aortic valve implantation

Nijenhuis

Brouwer

Søndergaard

et al. 2019

Heart

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This review provides a comprehensive overview of the available data on antithrombotic therapy after transcatheter aortic valve implantation (TAVI). In the absence of large randomised clinical trials, clinical practice is leaning towards evidence reported in other populations. Due to the greater risk of major bleeding associated with oral anticoagulation using a vitamin-K antagonist (VKA), antiplatelet therapy (APT) may be considered as the first-line treatment of patients undergoing TAVI. Overall, single rather than dual APT is preferred. However, dual APT should be considered in patients with a recent acute coronary syndrome (ie, within 6 months), complex coronary stenting, large aortic arch atheromas or previous non-cardioembolic stroke. Monotherapy with VKA should be considered if concomitant atrial fibrillation or any other indication for long-term oral anticoagulation is present. APT on top of VKA seems only reasonable in patients with recent acute coronary syndrome, extensive or recent coronary stenting or large aortic arch atheromas. A direct-acting oral anticoagulant may be considered if oral anticoagulation is indicated in the absence of contraindications. Initiation of VKA is indicated in clinical valve thrombosis, for example, with high transvalvular gradient, whereas the role of VKA in the case of subclinical leaflet thrombosis is currently uncertain.

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“…Valve thrombosis occurs predominantly during the first 2 years post-AVR with the initial 3–6 months period being at highest risk31 but may also occur later during follow-up 30. About 10%–20% of the cases of valve thrombosis are associated with severe HVD and symptoms; the rest of the cases are subclinical.…”

Section: Mechanisms and Risk Factors Of Svdmentioning

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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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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Natural history of subclinical leaflet thrombosis affecting motion in bioprosthetic aortic valves

Abstract: NCT02426307.

Cited by 185 publications

References 8 publications

Echocardiographic features of post−transcatheter aortic valve implantation thrombosis and endocarditis

Echocardiographic features of post−transcatheter aortic valve implantation thrombosis and endocarditis

Antithrombotic therapy in patients undergoing transcatheter aortic valve implantation

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

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