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The proliferation of transcatheter aortic valve implantation has alerted clinicians to a specific type of prosthetic degeneration represented by thrombosis. The pathogenesis of this clinical or subclinical phenomenon, which can occur in up to 15% of both surgical and percutaneous procedures, is poorly understood, as is its potential impact on patient prognosis and long-term bioprosthesis durability. Based on this lack of knowledge about the real meaning and importance of bioprosthetic valve thrombosis, the aim of the present review is to draw the clinicians’ attention to its existence, starting from the description of predisposing factors that may require a closer follow-up in such categories of patients, to an in-depth overview of all available imaging modalities with their respective pros and cons. Finally, a glimpse into the future of technology and biomarker development is presented. The hope is to increase the rate of bioprosthetic diagnosis, especially of the subclinical one, in order to understand (thanks to a strict and prolonged follow-up) if it can only be considered as an incidental tomographic entity without significant clinical consequences, or, on the contrary, if it is associated with neurological events or accelerated bioprosthetic degeneration. Nevertheless, despite the technical advances of echocardiography and cardiac tomography in terms of accurate bioprosthesis thrombosis detection, several diagnostic and therapeutic issues remain unresolved, including possible prevention strategies, tailored treatment protocols, and follow-up modalities. [ABSTRACT FROM AUTHOR]

The proliferation of transcatheter aortic valve implantation has alerted clinicians to a specific type of prosthetic degeneration represented by thrombosis. The pathogenesis of this clinical or subclinical phenomenon, which can occur in up to 15% of both surgical and percutaneous procedures, is poorly understood, as is its potential impact on patient prognosis and long-term bioprosthesis durability. Based on this lack of knowledge about the real meaning and importance of bioprosthetic valve thrombosis, the aim of the present review is to draw the clinicians' attention to its existence, starting from the description of predisposing factors that may require a closer follow-up in such categories of patients, to an in-depth overview of all available imaging modalities with their respective pros and cons. Finally, a glimpse into the future of technology and biomarker development is presented. The hope is to increase the rate of bioprosthetic diagnosis, especially of the subclinical one, in order to understand (thanks to a strict and prolonged follow-up) if it can only be considered as an incidental tomographic entity without significant clinical consequences, or, on the contrary, if it is associated with neurological events or accelerated bioprosthetic degeneration. Nevertheless, despite the technical advances of echocardiography and cardiac tomography in terms of accurate bioprosthesis thrombosis detection, several diagnostic and therapeutic issues remain unresolved, including possible prevention strategies, tailored treatment protocols, and follow-up modalities., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 The Author(s). Published by IMR Press.)

We used proteomics to identify systematic changes in the plasma proteins of patients undergoing coronary artery bypass grafting (CABG) by means of cardiopulmonary bypass surgery. It is known that, after CABG, a complex systemic inflammatory responses ensues that favors the occurrence of adverse postoperative complications frequently recognizing inflammation itself and/or thrombosis as the underlying mechanism. We found a marked and persistent postoperative increase in the levels of the serpin-protease inhibitor alpha(1)-antichymotrypsin (alpha(1)-ACT) that fully maintains the inhibitory activity blunting its protease substrate cathepsin G. An intraoperative increase followed by a rapid decline in proteases activation was documented, accompanied by a substantial induction of leucine-rich-alpha-2-glycoprotein, a protein involved in neutrophilic granulocyte differentiation. Finally, a time-dependent alteration in the expression of haptoglobin, transthyretin, clusterin, and apoE was observed. In conclusion, we showed that after CABG, a protease/antiprotease imbalance occurs with early cathepsin G activation and a more delayed increase in alpha(1)-ACT. As cathepsin G is a serpin involved both in inflammation and coagulation activation, this confirms and expands the concept of a marked dysregulation of both inflammatory and hemostatic balances occurring after CABG. The pharmacologic modulation of this imbalance may be a new therapeutic target to reduce postoperative complications.