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Rationale and design of a randomized clinical trial comparing safety and efficacy of Myval transcatheter heart valve versus contemporary transcatheter heart valves in patients with severe symptomatic aortic valve stenosis: the LANDMARK trial Timing of Intervention in Aortic Stenosis Minimizing Permanent Pacemaker Following Repositionable Self-Expanding Transcatheter Aortic Valve Replacement Suture- or Plug-Based Large-Bore Arteriotomy Closure: A Pilot Randomized Controlled Trial Bioprosthetic valve oversizing is associated with increased risk of valve thrombosis following TAVR Poor Long-Term Survival in Patients With Moderate Aortic Stenosis Frailty and Bleeding in Older Adults Undergoing TAVR or SAVR: Insights From the FRAILTY-AVR Study Aspirin with or without Clopidogrel after Transcatheter Aortic-Valve Implantation Health Status after Transcatheter vs. Surgical Aortic Valve Replacement in Low-Risk Patients with Aortic Stenosis Long-Term Outcomes of Anticoagulation for Bioprosthetic Valve Thrombosis
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Original Research2020 Sep 1;41(33):3184-3197

JOURNAL：Eur Heart J . Article Link

Leaflet immobility and thrombosis in transcatheter aortic valve replacement

ACT Ng, DR Holmes, MJ Mack et al. Keywords: antiplatelet therapy; antithrombotic treatment; thrombosis; transcatheter aortic valve replacement; transcatheter heart valve

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.
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