Transcatheter Aortic Valve Thrombosis

Hansson, Nicolaj C.; Grove, Erik Lerkevang; Andersen, Henning; Leipsic, Jonathon; Mathiassen, Ole Norling; Jensen, Jesper M.; Jensen, Kimmo; Blanke, Philipp; Leetmaa, Tina H; Tang, Mariann; Krusell, Lars Romer; Klaaborg, Kaj Erik; Christiansen, Evald Høj; Terp, Kim; Terkelsen, Christian Juhl; Poulsen, S.H.; Webb, John G.; Bøtker, Hans Erik; Nørgaard, Bjarne Linde

doi:10.1016/j.jacc.2016.08.010

Cited by 309 publications

(94 citation statements)

References 18 publications

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“…These findings further support the association between discontinuation of antiplatelets and the development of endocarditis reported in 1 study 28. Data from transcatheter aortic valve replacement (TAVR) studies refer to a significant risk of clinical/subclinical leaflet thrombosis that can be prevented and effectively treated by oral anticoagulation 51, 52. It is, however, unknown whether the same phenomenon is relevant to TPVI.…”

Section: Discussionsupporting

confidence: 71%

Infective Endocarditis After Melody Valve Implantation in the Pulmonary Position: A Systematic Review

Abdelghani

Nassif

Blom

et al. 2018

JAHA

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BackgroundInfective endocarditis (IE) after transcatheter pulmonary valve implantation (TPVI) in dysfunctioning right ventricular outflow tract conduits has evoked growing concerns. We aimed to investigate the incidence and the natural history of IE after TPVI with the Melody valve through a systematic review of published data.Methods and ResultsPubMed, EMBASE, and Web of Science databases were systematically searched for articles published until March 2017, reporting on IE after TPVI with the Melody valve. Nine studies (including 851 patients and 2060 patient‐years of follow‐up) were included in the analysis of the incidence of IE. The cumulative incidence of IE ranged from 3.2% to 25.0%, whereas the annualized incidence rate ranged from 1.3% to 9.1% per patient‐year. The median (interquartile range) time from TPVI to the onset of IE was 18.0 (9.0–30.4) months (range, 1.0–72.0 months). The most common findings were positive blood culture (93%), fever (89%), and new, significant, and/or progressive right ventricular outflow tract obstruction (79%); vegetations were detectable on echocardiography in only 34% of cases. Of 69 patients with IE after TPVI, 6 (8.7%) died and 35 (52%) underwent surgical and/or transcatheter reintervention. Death or reintervention was more common in patients with new/significant right ventricular outflow tract obstruction (69% versus 33%; P=0.042) and in patients with non‐streptococcal IE (73% versus 30%; P=0.001).ConclusionsThe incidence of IE after implantation of a Melody valve is significant, at least over the first 3 years after TPVI, and varies considerably between the studies. Although surgical/percutaneous reintervention is a common consequence, some patients can be managed medically, especially those with streptococcal infection and no right ventricular outflow tract obstruction.

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Section: Discussionsupporting

confidence: 71%

Infective Endocarditis After Melody Valve Implantation in the Pulmonary Position: A Systematic Review

Abdelghani

Nassif

Blom

et al. 2018

JAHA

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“…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.…”

Section: Assessment and Quantification Of Bioprosthetic Valve Dysfuncmentioning

confidence: 99%

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)

Capodanno

Petronio

Prendergast

et al. 2017

European Heart Journal

379

212

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“…Some studies found that patients undergoing TAVI had valve thrombosis, characterized by reduced leaflet motion, increased mean pressure gradients, and imaging abnormalities [13, 14, 36-38]. These studies demonstrated that oral anticoagulants have a protective effect.…”

Section: Discussionmentioning

confidence: 99%

“…In some studies involving patients undergoing TAVI who had valve thrombosis assessed by computed tomography, the incidence of valve thrombosis varied from 7 to 40%[13, 14]. Preventing ischemic events is very important, as this can decrease the risk of atrial fibrillation and device embolization.…”

Section: Introductionmentioning

confidence: 99%

Single versus Dual Antiplatelet Therapy after Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis

Yang

Wang

et al. 2018

Cardiology

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Objectives: Although dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is currently recommended in patients after transcatheter aortic valve implantation (TAVI), this practice is not supported by sufficient evidence. This study was performed to compare DAPT to single antiplatelet therapy (SAPT). Methods: An electronic search was completed of PubMed, Embase, Ovid Medline, Web of Science, and Cochrane Central Register of Controlled Trials. Studies comparing DAPT versus SAPT in patients undergoing TAVI were included. Results: Seven studies incorporating 1,445 patients were eligible for the present meta-analysis. There were no significant differences on 30-day all-cause mortality (OR 1.19, 95% CI 0.63–2.25, p = 0.593), 6-month all-cause mortality (OR 1.11, 95% CI 0.49–2.53, p = 0.796), or 1-year all-cause mortality (OR 1.19, 95% CI 0.63- 2.25, p = 0.593). DAPT was associated with an increased risk for 30-day (OR 2.91, 95% CI 1.85–4.58, p < 0.01), 6-month (OR 2.54, 95% CI 1.26–5.10, p < 0.001), and 1-year major and lethal bleeding (OR 2.65, 95% CI 1.04–6.77, p = 0.041) based on 896, 337, and 583 patients, respectively, compared to SAPT. Conclusion: Compared to SAPT, DAPT was not shown to be superior in reducing thrombotic events, but presented an increased risk of major/life-threatening bleeding. More randomized controlled trials are needed to provide further evidence.

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Transcatheter Aortic Valve Thrombosis

Abstract: Incidence of THV thrombosis in this large study was 7%. A larger THV size may predispose to THV thrombosis, whereas treatment with warfarin appears to have a protective effect. Although often subclinical, THV thrombosis may have important clinical implications.

Cited by 309 publications

References 18 publications

Infective Endocarditis After Melody Valve Implantation in the Pulmonary Position: A Systematic Review

Infective Endocarditis After Melody Valve Implantation in the Pulmonary Position: A Systematic Review

Single versus Dual Antiplatelet Therapy after Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis

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