The Fluid Mechanics of Transcatheter Heart Valve Leaflet Thrombosis in the Neosinus

BACKGROUND:Transcatheter heart valve (THV) thrombosis has been increasingly reported. In these studies, thrombus quantification has been based on a 2-dimensional assessment of a 3-dimensional phenomenon. METHODS:Postprocedural, 4-dimensional, volume-rendered CT data of patients with CoreValve, Evolu...

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Published in:Circulation (New York, N.Y.) N.Y.), 2017-10, Vol.136 (17), p.1598-1609
Main Authors: Midha, Prem A, Raghav, Vrishank, Sharma, Rahul, Condado, Jose F, Okafor, Ikechukwu U, Rami, Tanya, Kumar, Gautam, Thourani, Vinod H, Jilaihawi, Hasan, Babaliaros, Vasilis, Makkar, Raj R, Yoganathan, Ajit P
Format: Article
Language:English
Subjects:
Female
Heart Valves - surgery
Hemodynamics
Humans
Male
Models, Cardiovascular
Thrombosis - etiology
Thrombosis - physiopathology
Transcatheter Aortic Valve Replacement - adverse effects
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Summary:BACKGROUND:Transcatheter heart valve (THV) thrombosis has been increasingly reported. In these studies, thrombus quantification has been based on a 2-dimensional assessment of a 3-dimensional phenomenon. METHODS:Postprocedural, 4-dimensional, volume-rendered CT data of patients with CoreValve, Evolut R, and SAPIEN 3 transcatheter aortic valve replacement enrolled in the RESOLVE study (Assessment of Transcatheter and Surgical Aortic Bioprosthetic Valve Dysfunction With Multimodality Imaging and Its Treatment with Anticoagulation) were included in this analysis. Patients on anticoagulation were excluded. SAPIEN 3 and CoreValve/Evolut R patients with and without hypoattenuated leaflet thickening were included to study differences between groups. Patients were classified as having THV thrombosis if there was any evidence of hypoattenuated leaflet thickening. Anatomic and THV deployment geometries were analyzed, and thrombus volumes were computed through manual 3-dimensional reconstruction. We aimed to identify and evaluate risk factors that contribute to THV thrombosis through the combination of retrospective clinical data analysis and in vitro imaging in the space between the native and THV leaflets (neosinus). RESULTS:SAPIEN 3 valves with leaflet thrombosis were on average 10% further expanded (by diameter) than those without (95.5±5.2% versus 85.4±3.9%; P
ISSN:0009-7322
1524-4539
DOI:10.1161/CIRCULATIONAHA.117.029479