Leaflet immobility and thrombosis in transcatheter aortic valve replacement.

Abstract

Transcatheter aortic valve replacement (TAVR) has grown exponentially worldwide in the last decade. Due to the higher bleeding risks associated with oral anticoagulation and in patients undergoing TAVR, antiplatelet therapy is currently considered first-line antithrombotic treatment after TAVR. Recent studies suggest that some patients can develop subclinical transcatheter heart valve (THV) thrombosis after the procedure, whereby thrombus forms on the leaflets that can be a precursor to leaflet dysfunction. Compared with echocardiography, multidetector computed tomography is more sensitive at detecting THV thrombosis. Transcatheter heart valve thrombosis can occur while on dual antiplatelet therapy with aspirin and thienopyridine but significantly less with anticoagulation. This review summarizes the incidence and diagnostic criteria for THV thrombosis and discusses the pathophysiological mechanisms that may lead to thrombus formation, its natural history, potential clinical implications and treatment for these patients.

• Authors: Arnold C T Ng, David R Holmes, Michael J Mack, Victoria Delgado, Raj Makkar, Philipp Blanke, Jonathon A Leipsic, Martin B Leon, Jeroen J Bax
• Journal: European heart journal (Eur Heart J) Vol. 41 Issue 33 Pg. 3184-3197 (09 01 2020) ISSN: 1522-9645 [Electronic] England
• PMID: 32930773 (Publication Type: Journal Article, Review)
• Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: [email protected].

Topics

• Aortic Valve (diagnostic imaging, surgery)
• Aortic Valve Stenosis (surgery)
• Echocardiography
• Heart Valve Prosthesis (adverse effects)
• Humans
• Multidetector Computed Tomography
• Thrombosis (etiology)
• Transcatheter Aortic Valve Replacement (adverse effects)
• Treatment Outcome