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Transcatheter Aortic Valve Replacement in Low-risk Patients With Bicuspid Aortic Valve Stenosis Expert Recommendations on Cardiac Computed Tomography for Planning Transcatheter Left Atrial Appendage Occlusion 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines Minimalist transcatheter aortic valve replacement: The new standard for surgeons and cardiologists using transfemoral access? Contemporary real-world outcomes of surgical aortic valve replacement in 141,905 low-risk, intermediate-risk, and high-risk patients Incidence and Outcomes of Surgical Bailout During TAVR : Insights From the STS/ACC TVT Registry Coronary Access After TAVR Bioprosthetic valve oversizing is associated with increased risk of valve thrombosis following TAVR Increased Risk of Valvular Heart Disease in Systemic Sclerosis: An Underrecognized Cardiac Complication Aortic Valve Stenosis Treatment Disparities in the Underserved JACC Council Perspectives
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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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