Transcatheter Aortic Valve Thrombosis: Incidence, Predisposing Factors, and Clinical Implications

There are limited data on the incidence, clinical implications, and predisposing factors of transcatheter heart valve (THV) thrombosis following transcatheter aortic valve replacement (TAVR). The authors assessed the incidence, potential predictors, and clinical implications of THV thrombosis as det...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2016-11, Vol.68 (19), p.2059-2069
Main Authors: Hansson, Nicolaj C, Grove, Erik L, Andersen, Henning R, Leipsic, Jonathon, Mathiassen, Ole N, Jensen, Jesper M, Jensen, Kaare T, Blanke, Philipp, Leetmaa, Tina, Tang, Mariann, Krusell, Lars R, Klaaborg, Kaj E, Christiansen, Evald H, Terp, Kim, Terkelsen, Christian J, Poulsen, Steen H, Webb, John, Bøtker, Hans Erik, Nørgaard, Bjarne L
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Anticoagulants
Aortic Valve - diagnostic imaging
Aortic Valve - surgery
Aortic Valve Stenosis - diagnosis
Aortic Valve Stenosis - surgery
Aspirin
Cardiology
Denmark - epidemiology
Echocardiography, Transesophageal
Female
Follow-Up Studies
Humans
Incidence
Male
Medical imaging
Multidetector Computed Tomography
Patients
Postoperative Complications - diagnosis
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Prognosis
Retrospective Studies
Stroke
Studies
Thrombosis
Thrombosis - diagnosis
Thrombosis - epidemiology
Thrombosis - etiology
Transcatheter Aortic Valve Replacement - adverse effects
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Summary:There are limited data on the incidence, clinical implications, and predisposing factors of transcatheter heart valve (THV) thrombosis following transcatheter aortic valve replacement (TAVR). The authors assessed the incidence, potential predictors, and clinical implications of THV thrombosis as determined by contrast-enhanced multidetector computed tomography (MDCT) after TAVR. Among 460 consecutive patients who underwent TAVR with the Edwards Sapien XT or Sapien 3 (Edwards Lifesciences, Irvine, California) THV, 405 (88%) underwent MDCT in addition to transthoracic and transesophageal echocardiography 1 to 3 months post-TAVR. MDCT scans were evaluated for hypoattenuated leaflet thickening that indicated THV thrombosis. MDCT verified THV thrombosis in 28 of 405 (7%) patients. A total of 23 patients had subclinical THV thrombosis, whereas 5 (18%) patients experienced clinically overt obstructive THV thrombosis. THV thrombosis risk did not differ among different generations of THVs (8% vs. 6%; p = 0.42). The risk of THV thrombosis in patients who did not receive warfarin was higher compared with patients who received warfarin (10.7% vs. 1.8%; risk ratio [RR]: 6.09; 95% confidence interval [CI]: 1.86 to 19.84). A larger THV was associated with an increased risk of THV thrombosis (p = 0.03). In multivariable analysis, a 29-mm THV (RR: 2.89; 95% CI: 1.44 to 5.80) and no post-TAVR warfarin treatment (RR: 5.46; 95% CI: 1.68 to 17.7) independently predicted THV thrombosis. Treatment with warfarin effectively reverted THV thrombosis and normalized THV function in 85% of patients as documented by follow-up transesophageal echocardiography and MDCT. 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.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2016.08.010