Journal Article

Impact of leaflet thrombosis on valve haemodynamic status after transcatheter aortic valve replacement

Wei, Jeng, Lee, Jinho, Ko, Tsung-Yu, Kim, Hoyun, Lee, Seung-Ah, Jung, Seung Chai, Lam, Cheung Chi Simon, Kim, Kyung Won, Ko, Euihong, Kang, Se Hun, Kim, Won-Jang, Kang, Do-Yoon, Jang, Mi Hee, Kim, Dae-Hee, Wong, Yiu Tung Anthony, Lee, Yung-Tsai, Yin, Wei-Hsian, Choi, Yeonwoo, Lin, Mao-Shin, Kao, Hsien-Li, Yang, Dong Hyun, Ahn, Jung-Min, Koo, Hyun Jung, Park, Seung-Jung, Park, Duk-Woo, Kim, Byungjun

2024

Overview

ObjectivesThe effect of subclinical leaflet thrombosis, characterised by hypoattenuated leaflet thickening (HALT), on the valve haemodynamic function and durability of the bioprosthetic valve, is not yet determined. We determined the impact of HALT on valve haemodynamics after transcatheter aortic valve replacement (TAVR) and the predictors of haemodynamic structural valve deterioration (SVD).MethodsThe Anticoagulation vs Dual Antiplatelet Therapy for Prevention of Leaflet Thrombosis and Cerebral Embolization after Transcatheter Aortic Valve Replacement(ADAPT-TAVR) trial is a multicenter, randomised trial that compared edoxaban and dual antiplatelet therapy in patients who had undergone successful TAVR. The presence of HALT was evaluated by four-dimensional CT at 6 months and serial echocardiography performed at baseline, immediately post-TAVR and after 6 months. SVD was defined as at least one of the following: (1) mean transprosthetic gradient ≥20 mm Hg, (2) change in the mean gradient ≥10 mm Hg from baseline, or (3) new or increase in intraprosthetic aortic regurgitation of at least ≥1 grade, resulting in moderate or greater regurgitation.ResultsAt 6 months, HALT was found in 30 of 211 (14.2%) patients. The presence of HALT did not significantly affect aortic valve mean gradients (with vs without HALT; 14.0±4.8 mm Hg vs 13.7±5.5 mm Hg; p=0.74) at 6 months. SVD was reported in 30 of 206 patients (14.6%) at 6-month follow-up echocardiography. Older age (OR: 1.138; 95% CI: 1.019 to 1.293; p=0.033), use of aortic valve size ≤23 mm (OR: 6.254; 95% CI: 2.230 to 20.569; p=0.001) and mean post-TAVR pressure gradient (OR: 1.233; 95% CI: 1.123 to 1.371; p<0.001) were independent predictors of haemodynamic SVD; however, the presence of HALT was not identified as a predictor of SVD.ConclusionsIn patients who had undergone successful TAVR, aortic valve haemodynamic status was not influenced by the presence of HALT. Although HALT was not a predictor of haemodynamic SVD at 6 months, it warrants further longer-term follow-up to evaluate the effect on long-term valve durability.Trial registration numberNCT03284827 (https://www.clinicaltrials.gov).

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ,BMJ Publishing Group LTD
• Subject: Aortic Valve - diagnostic imaging / Aortic Valve - surgery / Aortic Valve Stenosis / Heart Valve Prosthesis - adverse effects / Hemodynamics / Humans / Medical imaging / Patients / Platelet Aggregation Inhibitors - therapeutic use / Regression analysis / Thromboembolism / Thrombosis / Thrombosis - diagnostic imaging / Thrombosis - etiology / Thrombosis - prevention & control / transcatheter aortic valve replacement / Transcatheter Aortic Valve Replacement - adverse effects / Transcatheter Aortic Valve Replacement - methods / Treatment Outcome / Valvular heart disease / Variables / Velocity