Might Coronary Flow Influence Transcatheter Heart Valve Neo-Sinus Thrombosis?

Madukauwa-David, Immanuel David; Sadri, Vahid; Midha, Prem A.; Babaliaros, Vasilis; Sharma, Rahul; Makkar, Raj; Yoganathan, Ajit P.

doi:10.1161/circinterventions.119.008005

Cited by 8 publications

(5 citation statements)

References 5 publications

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“…This fluid mechanicsbased observation is supported by a clinical study of 1644 cases that reported an occurrence rate of thrombosis for intra-annular valves of 13.5%, which is significantly higher than the 7% for supra-annular valves [44]. Additional corroborations include the analysis of washout time, which demonstrated that intra-annular valves have a slower washout time than supra-annular valves [29,40,41,45]. The reason for this becomes apparent when examining the volumetric size of the neo-sinus in these valves: the neo-sinus is much larger for an intra-annular valve, as illustrated in figure 4 [39,44].…”

Section: Influence Of Transcatheter Aortic Valve Implantation Depthmentioning

confidence: 64%

Transcatheter aortic valve thrombosis: a review of potential mechanisms

Raghav

Midha

Sharma

et al. 2021

J. R. Soc. Interface.

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Transcatheter aortic valve (TAV) thrombosis has been recognized as a significant problem that sometimes occurs as early as within 30 days after valve implantation, leading to increased concerns of stroke and long-term valve durability. In this article, a critical summary of the relevant literature on identifying potential mechanisms of TAV thrombosis from the perspective of the well-known Virchow's triad, which comprises blood flow, foreign materials and blood biochemistry, is presented. Blood flow mechanisms have been the primary focus thus far, with a general consensus on the flow mechanisms with respect to haemodynamic conditions, the influence of TAV placement and expansion and the influence of coronary flow. Less attention has been paid to the influence of blood biochemistry and foreign materials (and related endothelial damage), with little consensus among studies with regards to platelet and/or microparticle levels post-TAV implantation. Finally, we discuss the future outlook for research with unanswered scientific questions.

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Section: Influence Of Transcatheter Aortic Valve Implantation Depthmentioning

confidence: 64%

Transcatheter aortic valve thrombosis: a review of potential mechanisms

Raghav

Midha

Sharma

et al. 2021

J. R. Soc. Interface.

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“…While distinct, both processes are thought to be sequelae from impaired perfusion or flow to the coronary sinuses ( 17 – 21 ). The shorter or more compact sinus of valsalva, following valve deployment, promotes flow stagnation and subsequent platelet aggregation leading to atherothrombosis in the coronary vessel or bioprosthetic valve ( 22 , 23 , 33 ).…”

Section: Discussionmentioning

confidence: 99%

“…When considering the lifetime management of aortic stenosis (AS), several authors have raised concerns on the impact of the implantation of a second (and additional) transcatheter heart valve ( 18 – 23 ) on coronary flow and sinus thrombosis potentially impacting coronary flow.…”

Section: Introductionmentioning

confidence: 99%

New adverse coronary events in valve-in-valve TAVR and native TAVR—A 2-year matched cohort

Koren

Patel²,

Naami³

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveTo assess the incidence of new adverse coronary events (NACE) following transcatheter aortic valve replacement (TAVR) and valve-in-valve TAVR (ViV-TAVR).BackgroundViV-TAVR is an accepted treatment for degenerative prostheses among patients with high surgical-risk. TAVR studies have suggested an increased risk of coronary artery obstruction and flow stasis causing thrombus formation. Whether contemporary ViV-TAVR is associated with higher rate of coronary events compared to TAVR is unknown.MethodsWe used data from 1,224 TAVR patients between 2016 and 2021. We propensity-matched patients following ViV-TAVR and TAVR by significant predictors to overcome confounders in patients' baseline characteristics and procedural factors.ResultsThe matched population included 129 patients in each group. In line with prior reports, there was a higher in-hospital coronary artery obstruction rate with ViV-TAVR (3.1 vs. 1.6%; p = 0.23). Despite this, 2-year cumulative NACE rates were similar between groups (4.7 vs. 6.2%, respectively, p = 0.79), with no difference between its components: myocardial infarction (MI) (p = 0.210), unplanned coronary catheterization (p = 0.477), or coronary artery bypass grafting (CABG) (p = 0.998). Moreover, hypoattenuated leaflets thickening (HALT) at 30-day CT was observed in nearly a quarter of the patients with no difference between groups (23.9 vs. 23.1%, HR 1.02, 95% CI 0.50–1.28, p = 0.872). The progression rate of the coronary artery calcium score (CACS), assessed in a third of patients, was similar between groups (p log-rank = 0.468, 95% CI 0.12–1.24). Low coronary artery height was an unfavorable predictor for in-hospital coronary obstruction and 2-year NACE rate (HR 1.20 and HR 1.25, p = 0.001 and p < 0.0001, respectively).ConclusionAt 2-year follow-up, ViV-TAVR was not associated with a higher rate of myocardial infarction, unplanned catheterization, coronary artery bypass grafting, or hypoattenuated leaflet thickening.

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“…Slow blood flow Turbulence Incomplete apposition [80,81], Hypercoagulability [82,83], Turbulence [84,85], and Incomplete apposition [86,87] can be found through the cited sources. See [2] for a more detailed list of factors involved in prosthetic valve thrombosis.…”

Section: Mitral Valvementioning

confidence: 99%

“…Hemostatic and hemodynamic factors involved in the development of prosthetic valve thromboses. Additional information regarding Slow blood flow[80,81], Hypercoagulability[82,83], Turbulence[84,85], and Incomplete apposition[86,87] can be found through the cited sources. See[2] for a more detailed list of factors involved in prosthetic valve thrombosis.…”

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confidence: 99%

Management of Intracranial Hemorrhage in the Setting of Mechanical Heart Valve Replacement Therapy

2023

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The management of an intracranial hemorrhage in patients receiving anticoagulant therapy presents a significant challenge for medical professionals. Anticoagulant treatment is intended to prevent blood clotting, but it can worsen active brain bleeds. Despite this risk, avoiding the prothrombotic state caused by mechanical heart valves remains crucial. Guidelines on managing this issue are currently lacking, prompting a review that delves into embryonic development and anatomical functions of heart valves, valve replacement therapy for diseased valves, and the need for anticoagulants. Ultimately, recent literature and cases inform discussion regarding how best to manage intracranial hemorrhages in patients with mechanical heart valves. The expectation is that this examination will offer valuable perspectives on the handling of intracranial bleeding among individuals with mechanical heart valves and stimulate additional investigations in this intricate domain, particularly through the lens of applied mechanics.

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Might Coronary Flow Influence Transcatheter Heart Valve Neo-Sinus Thrombosis?

Cited by 8 publications

References 5 publications

Transcatheter aortic valve thrombosis: a review of potential mechanisms

Transcatheter aortic valve thrombosis: a review of potential mechanisms

New adverse coronary events in valve-in-valve TAVR and native TAVR—A 2-year matched cohort

Management of Intracranial Hemorrhage in the Setting of Mechanical Heart Valve Replacement Therapy

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