Clinical predictors and sequelae of computed tomography defined leaflet thrombosis following transcatheter aortic valve replacement at medium-term follow-up

Rashid, H.; Michail, Michael; Ihdayhid, Abdul Rahman; Dowling, Cameron; Khav, Nancy; Tan, Sean; Ramnarain, J.; Cameron, J.; Nasis, Arthur; Nicholls, Stephen J.; Gooley, Robert

doi:10.1007/s00380-021-01803-4

Cited by 10 publications

(3 citation statements)

References 42 publications

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“…The current analysis offers a detailed examination of potential predictors for HALT after TAVI in cardiac CT. In the literature, several clinical and procedural contributors to HALT after TAVI have been described, such as the absence of oral anticoagulation, the use of a large prosthesis, moderate-to-severe paravalvular leakage or balloon-expandable valves [ 26 – 29 ]. The current analysis extends the knowledge about potential predictors for HALT after TAVI.…”

Section: Discussionmentioning

confidence: 99%

Commissural misalignment independently predicts leaflet thrombosis after transcatheter aortic valve implantation

et al. 2023

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Aims Transcatheter aortic valve implantation (TAVI) has become a minimally invasive alternative to surgical aortic valve replacement. Hypo-attenuated leaflet thickening (HALT)—a marker of subclinical leaflet thrombosis commonly detected by cardiac computed tomography (CT) after TAVI—may influence valve durability and function. The purpose of this study was to compare commissural alignment of the native and prosthetic aortic valves in cardiac CT in subjects with and without HALT and thereby identify commissural misalignment as potential predictor for leaflet thrombosis after TAVI. Methods and results In 170 subjects, 85 with and 85 without HALT in post-TAVI CT, commissural orientation of the prosthesis was determined comparing native and prosthetic aortic valve orientation in cardiac CT by measuring the commissural angle relative to the right coronary ostium in the aortic valve plane. For the prosthetic valve, any deviation ≤ 15° compared to the native valve was classified as “aligned”; 16–30° as “mild”, 31–45° as “moderate” and ≥ 45° as “severe” misalignment. Among subjects with HALT, median angular deviation was higher (36°, IQR 31°) than in the control group (29°, IQR 29°, p = 0.042). “Severe” misalignment was more frequent in subjects who developed HALT (n = 31, 37%) compared to the control group (n = 17, 20%, p = 0.013). In logistic regression analysis, more severe deviation (p = 0.015, OR = 1.02 per 1° deviation) and “severe” misalignment (p = 0.018, OR = 2.2) represented independent predictors for the occurrence of HALT after TAVI. Conclusion Subclinical leaflet thrombosis after TAVI is associated with commissural misalignment. Potential clinical advantages of obtaining commissural alignment remain to be systematically assessed. Graphical abstract Association of HALT with commissural misalignment after TAVI. HALT hypo-attenuated leaflet thickening, IQR interquartile range, TAVI transfemoral aortic valve replacement

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Section: Discussionmentioning

confidence: 99%

Commissural misalignment independently predicts leaflet thrombosis after transcatheter aortic valve implantation

et al. 2023

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“…This test can identify prosthesis thrombosis through morphological criteria with a finding of HALT that may be associated with HAM, and the possibility of assessing the thrombotic load, a parameter that has been correlated with adverse clinical outcomes. 4,9,10 HALT can be classified according to the extent of leaflet involvement as <25%, 25-50%, 50-75% or >75%, with this assessment being performed on CT diastolic reconstructions (Figure 6). However, the presence of HALT is observed at similar rates for transcatheter and surgical prosthetic valves.…”

Section: Discussionmentioning

confidence: 99%

“…11 Symptomatic thrombosis of aortic valve endoprosthesis leaflets is rare, representing about 0.6 to 2.8% of reported cases, 8 contrasting with incidental finding in about 15-40% of subclinical thrombosis with evidence of HALT on cardiac CT, with a potential association with cerebrovascular events. 5,7,9 Optimal antithrombotic therapy is still the focus of clinical trials, with current guidelines recommending dual antiplatelet therapy (DAPT) for three to six months after TAVI and data regarding safety and longevity suggesting good durability in five years. 1,7 However, some studies suggest that subclinical thrombosis is more common in those who did not receive anticoagulation, so that, after discontinuing DOAC, CT can reveal HALT in a variable degree, revealing its dynamic nature due to the potential of spontaneous progression or regression, even in asymptomatic patients.…”

Section: Discussionmentioning

confidence: 99%

Role of Multimodality for the Diagnosis of Thrombosis at Late Follow-up of Patients Selected for TAVI: Review of a Case Series

Gomes¹,

Souza²,

Drubi³

et al. 2023

ABC Imagem Cardiovascular

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Subclinical leaflet thrombosis after transcatheter aortic valve replacement and anticoagulant treatment: lights and shadows

Condello

Sturla

Terzi

2021

J Thromb Thrombolysis

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Clinical predictors and sequelae of computed tomography defined leaflet thrombosis following transcatheter aortic valve replacement at medium-term follow-up

Cited by 10 publications

References 42 publications

Commissural misalignment independently predicts leaflet thrombosis after transcatheter aortic valve implantation

Commissural misalignment independently predicts leaflet thrombosis after transcatheter aortic valve implantation

Role of Multimodality for the Diagnosis of Thrombosis at Late Follow-up of Patients Selected for TAVI: Review of a Case Series

Subclinical leaflet thrombosis after transcatheter aortic valve replacement and anticoagulant treatment: lights and shadows

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