Early Aortic Transcatheter Heart Valve Thrombosis

Abstract

Background— Early stent valve thrombosis after transcatheter aortic valve implantation (TAVI) is a rare complication, which is diagnosed based on the appearance of clinical symptoms of heart failure and echocardiographic findings. After TAVI, transthoracic echocardiography is performed to assess transcatheter heart valve (THV) function. However, preliminary reports indicate the potential additive clinical value of multidetector computed tomography (MDCT) for the diagnosis of THV thrombosis. We sought to determine the value of MDCT for the diagnosis of THV thrombosis and the frequency of this complication after balloon-expandable TAVI. Methods and Results— MDCT was performed in 140 patients within 1 to 3 months after TAVI with the Edwards Sapien XT THV to assess the presence of THV thrombosis and THV stent geometry. Post-TAVI MDCT identified THV thrombosis in 5 patients (4%). Of note, 4 of these patients were asymptomatic and had a normal transthoracic echocardiographic examination without signs of thrombus formation or flow obstruction. In patients with THV thrombosis, a left ventricular ejection fraction of <35% was present in 3 (60%), whereas 2 (40%) did not receive standard post-TAVI dual-antiplatelet therapy. Neither THV underexpansion nor THV noncircularity was detected in patients with THV thrombosis. Conclusions— Post-TAVI MDCT is a valuable tool for the diagnosis of THV thrombosis, and this complication seems to be more common than previously anticipated. Larger studies are required to identify specific risk factors of THV thrombosis.

Standardized definitions of structural deterioration and valve failure in assessing long-term durability of transcatheter and surgical aortic bioprosthetic valves: a consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorsed by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)

“…These include 2D/3D echocardiography, multi-detector computed tomography (MDCT) and magnetic resonance imaging (MRI). [11][12][13] Echocardiography is a 'functional' imaging modality and superior for the demonstration of valve haemodynamics (i.e. increased transvalvular gradient, valve regurgitation), whereas MDCT provides more 'anatomical' and structural information.…”

Hot topics in transcatheter aortic valve implantation

“…More recently, hypoattenuated leaflet thickening (HALT) and reduced leaflet motion (RELM) of bioprosthetic aortic valves associated with normal transvalvular gradients (possibly related to subclinical leaflet thrombosis) have been reported as affecting both transcatheter and surgical aortic valves. The prevalence of this finding ranged from 4 to 20% [14][15][16]. An interesting finding was that HALT/RELM was actually not observed in patients on anticoagulant therapy and resolved with initiation of anticoagulation [14][15][16]; these clues seem to further confirm that this finding is related to THV thrombosis.…”

“…The prevalence of this finding ranged from 4 to 20% [14][15][16]. An interesting finding was that HALT/RELM was actually not observed in patients on anticoagulant therapy and resolved with initiation of anticoagulation [14][15][16]; these clues seem to further confirm that this finding is related to THV thrombosis. On one hand, in view of the available evidence, it may be reasonable to anticoagulate patients with symptomatic THV thrombosis (HALT/RELM) for 1-3 months.…”

Stented Bioprosthesis in Aortic Position: Analysis of the Early Results Based on a Retrospective Study

“…При этом у пациентки не отмечено каких-либо проблем с достижением целевых значений МНО или пропусков приема антикоагулянтов. Подоб-ные случаи описаны у зарубежных авторов [16,17], а причина чаще всего однозначно не указы-вается. В нашем наблюдении мы также не можем однозначно определить причину формирования тромба.…”