Very Late Thrombosis of a Transcatheter Aortic Valve-in-Valve

Surgical explantation of transcatheter aortic bioprostheses: Results and clinical implications

“…Surgical explantation of older TAVR valve cases are increasingly reported recently, being exclusively after 2015. 4,10,[15][16][17] The description of the valve or the aortic finding in these reports is in line with our observations. Aortic endarterectomy is seemingly mandatory with respect to valves older than a year after implantation and unplanned aortic replacement appears frequently necessary in these old valve cases.…”

“…As for previous TAVR valve explant and recommended surgical technique in the literature, we have identified 11 case reports that involved description of valve explant technique from 2008 to 2019. 4,10,[15][16][17][18][19][20][21][22][23] The time interval between TAVR implant and explant was from immediate to 7 years (median 187 days; IQR, 21-913 days). Surgical explantation of older TAVR valve cases are increasingly reported recently, being exclusively after 2015.…”

Blood Stasis on Transcatheter Valve Leaflets and Implications for Valve-in-Valve Leaflet Thrombosis

“…A recent clinical study has suggested that the frequency of post-TAVR thrombus formation may be as high as 40% [6]. In addition, valve thrombosis has been increasingly observed in patients undergoing valve-in-valve (ViV) procedures [7][8][9][10]. The thrombotic materials after TAVR and ViV procedures are predominantly found on the aortic side of the leaflets (Figs 1a, 1b) [6,7,11].…”

“…(a) Thrombotic material adhered to the three leaflets of the Sapien XT after valve-in-valve in the CoreValve. (Reprinted from[8] with permission from Elsevier.) (b) Note the greater presence of a redbrown post-transcatheter aortic valve replacement thrombus (red arrow) on the aortic surface of the right coronary cusp (RCC) of the CoreValve.…”

Subclinical leaflet thrombosis following transcatheter aortic valve replacement

“…Autopsy findings have also shown the presence of thrombus on the right and noncoronary leaflets of a CoreValve implanted within another CoreValve THV . Marti et al reported thrombotic material on all three leaflets of a SAPIEN XT implanted within a CoreValve THV. Furthermore, thrombus formation has also been observed on a SAPIEN XT in a Hancock II bioprosthesis following transcatheter mitral ViV implantation …”