Transcatheter aortic valve thrombosis: the relation between hypo-attenuated leaflet thickening, abnormal valve haemodynamics, and stroke

Vollema, E. Mara; Kong, William Kok-Fai; Katsanos, Spyridon; Kamperidis, Vasileios; Rosendael, Philippe J. van; Kley, Frank van der; Weger, Arend de; Marsan, Nina Ajmone; Delgado, Victoria; Bax, Jeroen J.

doi:10.1093/eurheartj/ehx031

Cited by 113 publications

(71 citation statements)

References 28 publications

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“…Prior studies evaluating obstructive prosthetic valve thrombosis after TAVR, with patients often presenting with heart failure symptoms or increased transprosthetic gradients on follow-up echocardiography, have reported relatively low incidences ranging from 0.61 to 2.8% [65][66][67]. However, studies performing (4D) CT post-TAVR regardless of symptoms or transprosthetic gradients have detected the presence of hypoattenuated leaflet thickening with or without reduced leaflet motion suggestive of subclinical leaflet thrombosis in a significantly higher proportion of patients, with incidences ranging from 4 to 40% [68][69][70][71][72][73][74].…”

Section: Further Considerationsmentioning

confidence: 99%

Echocardiography in Transcatheter Aortic Valve Replacement

Vollema

Delgado

Bax

2019

Heart, Lung and Circulation

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Section: Further Considerationsmentioning

confidence: 99%

Echocardiography in Transcatheter Aortic Valve Replacement

Vollema

Delgado

Bax

2019

Heart, Lung and Circulation

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“…Leaflet thrombosis (LT, also called cusp thrombosis) is a common complication in bAVR with a prevalence of about 7% to 15% detected on multi‐detector computed tomography (MDCT) . MDCT has been proven to be a more sensitive method for detection of (LT), which is characterized by hypoattenuated leaflet thickening (HALT) and a reduction in leaflet motion (RELM) . Some studies report contradictory findings about the association of adverse clinical events with MDCT‐defined LT in bAVR .…”

Section: Introductionmentioning

confidence: 99%

Impact of leaflet thrombosis on hemodynamics and clinical outcomes after bioprosthetic aortic valve replacement: A meta‐analysis

Tian

2020

Clinical Cardiology

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Background: Leaflet thrombosis (LT, also called cusp thrombosis) detected by multidetector computed tomography (MDCT) is common in bioprosthetic aortic valve replacement (bAVR). However, it remains contradictory whether MDCT-defined LT following bAVR is associated with hemodynamic deterioration and stroke. Thus, we performed the first meta-analysis to assess hemodynamic outcomes and updated the latest researches on the clinical outcomes of MDCT-defined LT after bAVR. Hypothesis: MDCT-defined LT might be associated with worse hemodynamic and clinical outcomes after bAVR. Method: MEDLINE, EMBASE, Cochrane Library, and ClinicalTrial.gov were searched from inception to 15th April 2019. The fix-effect model was utilized to calculate odds ratio (OR) and 95% confidence interval (CI). The primary outcomes were hemodynamic stability indexes, including mean pressure gradient (MPG), left ventricular ejection fraction (LVEF), paravalvular leak (PVL), and clinical heart failure. The secondary endpoints were major adverse cardiovascular and cerebrovascular events (MACCEs), which consisted of myocardial infarction, all-cause death, stroke, and transient ischemic attack (TIA).Results: Twelve studies with 4820 patients were included. The total prevalence of MDCT-defined LT was 9.7%. MDCT-defined LT was associated with a significantly increased risk of MPG (inverse variance 0.43, 95% CI: [0.30, 0.57]), MACCEs (OR 2.43, 95% CI: [1.45, 4.06]), stroke (OR 1.79, 95% CI: [1.03, 3.11]), and TIA (OR 4.09, 95% CI: [1.59, 10.54]). There were no differences for other outcomes.Conclusions: MDCT-defined LT after bAVR is associated with increased MPG and increased risk of adverse cerebrovascular events, including TIA and stroke. While LVEF, PVL, and clinical heart failure were similar between patient with and without LT. K E Y W O R D S aortic stenosis, bioprosthetic aortic valve, surgical aortic valve replacement, thrombosis, transcatheter aortic valve replacement

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“…The cause of LT is multifactorial from a combination of, but not limited to, antithrombotic strategy, prosthesis geometry, and pro‐hemostatic factors . A recent report suggests intra‐annular valves (IAV) have a larger neo‐sinus and stagnation zone when compared to supra‐annular valves (SAV) with an in vitro flow model, which might increase the likelihood of LT (Figure ) .…”

Section: Introductionmentioning

confidence: 99%

The prevalence of computed tomography‐defined leaflet thrombosis in intra‐ versus supra‐annular transcatheter aortic valve prostheses

Rashid

Nasis

Gooley

et al. 2018

Cathet Cardio Intervent

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Transcatheter aortic valve thrombosis: the relation between hypo-attenuated leaflet thickening, abnormal valve haemodynamics, and stroke

Abstract: On MDCT, 12.5% of patients showed HALT or reduced leaflet motion, whereas only one of these patients had abnormal valve haemodynamics on echocardiography. Neither HALT nor increased transvalvular gradient were associated with stroke/TIA.

Cited by 113 publications

References 28 publications

Echocardiography in Transcatheter Aortic Valve Replacement

Echocardiography in Transcatheter Aortic Valve Replacement

Impact of leaflet thrombosis on hemodynamics and clinical outcomes after bioprosthetic aortic valve replacement: A meta‐analysis

The prevalence of computed tomography‐defined leaflet thrombosis in intra‐ versus supra‐annular transcatheter aortic valve prostheses

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