Impact of CT-ADP point-of-care assay on 30-day paravalvular aortic regurgitation and bleeding events following transcatheter aortic valve replacement

Background Paravalvular aortic regurgitation (PAVR) remains a frequent post-procedural concern following transcatheter aortic valve replacement (TAVR). Persistence of flow turbulence results in the cleavage of high molecular weight von Willebrand multimers, primary hemostasis dysfunction and may favour bleedings. Recent data have emphasized the value of a point-of-care measure of von Willebrand factor-dependent platelet function (closure-time (CT)-ADP) in the monitoring of immediate PA. This study examined whether CT-ADP could detect PAVR at 30 days and bleeding complications following TAVR. Methods CT-ADP was assessed at baseline and the day after the procedure. At 30 days, significant PAVR was defined as a circumferential extent of regurgitation greater than 10% by transthoracic echocardiography. Events at follow-up were assessed according to the VARC-2 classification. Results Significant PAVR was diagnosed in 44/219 patients. Important reduction of CT-ADP could be found in patients without PAVR, contrasting with the lack of CT-ADP improvement in significant PAVR patients. By univariate analysis, a self-expendable valve, valve size ≥ 31 mm and CT-ADP > 180 s were associated with PAVR. By multivariate analysis, CT-ADP > 180 s (HR 5.1 95% CI (2.5–10.6); P 180 s, but not PAVR, was proven to be an independent predictor of major/life-threatening bleeding (HR 1.813 (1.014–3.241); P = 0.045) [ Table 1 , Fig. 1 ]). Conclusion Post-procedural CT-ADP > 180 s is an independent predictor of significant PAVR 30 days after TAVR and may independently contribute to major/life-threatening bleedings. Other parameters such LVEF should be taken into account in the interpretation of prolonged CT-ADP time following valve implantation.