Leaflet immobility and thrombosis in transcatheter aortic valve replacement. (14th September 2020)

• Record Type: Journal Article
• Authors: Ng, Arnold C T; Holmes, David R; Mack, Michael J; Delgado, Victoria; Makkar, Raj; Blanke, Philipp; Leipsic, Jonathon A; Leon, Martin B; Bax, Jeroen J
• Is Part Of: European heart journal. Volume 41:Number 33(2020)
• Page Start: 3184
• Page End: 3197
• Publication Date: 2020-09-14
• Subjects: Thrombosis -- Transcatheter aortic valve replacement -- Antiplatelet therapy -- Antithrombotic treatment -- Transcatheter heart valve; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehaa542
• Languages: English
• ISSNs: 0195-668X

Abstract

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. Graphical Abstract: