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Transcatheter Aortic Valve Thrombosis: Incidence, Predisposing Factors, and Clinical Implications.
- Source :
-
Journal of the American College of Cardiology (JACC) . Nov2016, Vol. 68 Issue 19, p2059-2069. 11p. - Publication Year :
- 2016
-
Abstract
- <bold>Background: </bold>There are limited data on the incidence, clinical implications, and predisposing factors of transcatheter heart valve (THV) thrombosis following transcatheter aortic valve replacement (TAVR).<bold>Objectives: </bold>The authors assessed the incidence, potential predictors, and clinical implications of THV thrombosis as determined by contrast-enhanced multidetector computed tomography (MDCT) after TAVR.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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. [ABSTRACT FROM AUTHOR]
- Subjects :
- *AORTIC valve diseases
*THROMBOSIS
*DISEASE incidence
*DISEASE susceptibility
*TRANSESOPHAGEAL echocardiography
*THROMBOSIS diagnosis
*AORTIC valve
*AORTIC stenosis
*PROSTHETIC heart valves
*LONGITUDINAL method
*PROGNOSIS
*RETROSPECTIVE studies
*SURGICAL complications
*MULTIDETECTOR computed tomography
*DIAGNOSIS
AORTIC valve surgery
Subjects
Details
- Language :
- English
- ISSN :
- 07351097
- Volume :
- 68
- Issue :
- 19
- Database :
- Academic Search Index
- Journal :
- Journal of the American College of Cardiology (JACC)
- Publication Type :
- Academic Journal
- Accession number :
- 118922885
- Full Text :
- https://doi.org/10.1016/j.jacc.2016.08.010