Clinical predictors and sequelae of computed tomography defined leaflet thrombosis following transcatheter aortic valve replacement at medium-term follow-up

Background The clinical predictors and sequelae of leaflet thrombosis (LT) following transcatheter aortic valve replacement (TAVR) is still unclear. Therefore, our aim was to determine the clinical predictors and sequelae at mid-term follow-up of computed tomography (CT)-defined LT following TAVR. M...

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Published in:Heart and vessels 2021-09, Vol.36 (9), p.1374-1383
Main Authors: Rashid, Hashrul N., Michail, Michael, Ihdayhid, Abdul R., Dowling, Cameron, Khav, Nancy, Tan, Sean, Ramnarain, Jaineel, Cameron, James D., Nasis, Arthur, Nicholls, Stephen J., Gooley, Robert P.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Anticoagulants
Aorta
Aortic valve
Aortic Valve - diagnostic imaging
Aortic Valve - surgery
Aortic Valve Stenosis - surgery
Biomedical Engineering and Bioengineering
Cardiac Surgery
Cardiology
Complications
Computed tomography
Durability
Female
Follow-Up Studies
Heart Valve Prosthesis
Heart valves
Humans
Male
Medicine
Medicine & Public Health
Multidetector Computed Tomography
Multivariate analysis
Original Article
Patients
Prostheses
Prosthetics
Regurgitation
Thickening
Thromboembolism
Thrombosis
Thrombosis - diagnostic imaging
Thrombosis - epidemiology
Thrombosis - etiology
Tomography
Transcatheter Aortic Valve Replacement - adverse effects
Vascular Surgery
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Summary:Background The clinical predictors and sequelae of leaflet thrombosis (LT) following transcatheter aortic valve replacement (TAVR) is still unclear. Therefore, our aim was to determine the clinical predictors and sequelae at mid-term follow-up of computed tomography (CT)-defined LT following TAVR. Methods and results We performed a prospective evaluation with a 320-multislice CT following TAVR for the presence of LT, defined as hypo-attenuated leaflet thickening (HALT). Four-dimensional CT image-rendering was performed to determine the presence of reduced leaflet motion (RELM). 172 patients [89 (51.7%) male, mean age 82.8 ± 5.7 years] treated with commercially available TAVR device (Lotus 54%, CoreValve 32% and Sapien 3 14%) were included, with median CT-scan at 6.0 weeks post-TAVR. Prevalence of HALT was 14.0% (24 cases) and RELM was 9.8% (17 cases). On multivariate analysis, patients with HALT were less prescribed oral anticoagulation (OAC) (OR 9.9), received larger TAVR prostheses (OR 5.7) and higher rates of moderate-severe para-valvular regurgitation (PVR) (OR 16.3). There was no difference in clinical outcomes at a median follow-up of 2.3 years. Patients with RELM had significantly higher transvalvular gradients after discharge when compared to those without RELM. Conclusions Absence of OAC, large TAVR prostheses and moderate-severe PVR were predictors for LT. Transvalvular gradients were higher in patients that developed RELM but not HALT. Further studies are warranted to determine the long-term impact of LT on TAVR durability. Graphic abstract Prevalence of different sub-types of CT-defined LT (HALT and RELM) and the clinical predictors of developing LT following TAVR. CT computed tomography, HALT hypo-attenuated leaflet thickening, LT leaflet thrombosis, RELM reduced leaflet motion, TAVR transcatheter aortic valve replacement
ISSN:0910-8327
1615-2573
DOI:10.1007/s00380-021-01803-4