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Prevalence and Outcomes of Concomitant Aortic Stenosis and Cardiac Amyloidosis 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 Poor Long-Term Survival in Patients With Moderate Aortic Stenosis Prior Balloon Valvuloplasty Versus Direct Transcatheter Aortic Valve Replacement: Results From the DIRECTAVI Trial Clinical Impact of Valvular Heart Disease in Elderly Patients Admitted for Acute Coronary Syndrome: Insights From the Elderly-ACS 2 Study Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis Coronary Access After TAVR Association of Smoking Status With Long‐Term Mortality and Health Status After Transcatheter Aortic Valve Replacement: Insights From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis Predictors and Clinical Outcomes of Next-Day Discharge After Minimalist Transfemoral Transcatheter Aortic Valve Replacement
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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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