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Bioprosthetic valve oversizing is associated with increased risk of valve thrombosis following TAVR Transcatheter Aortic Valve Replacement in Low-risk Patients With Bicuspid Aortic Valve Stenosis Considerations for Optimal Device Selection in Transcatheter Aortic Valve Replacement: A Review Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis Frailty and Bleeding in Older Adults Undergoing TAVR or SAVR: Insights From the FRAILTY-AVR Study Transcatheter aortic-valve replacement with a self-expanding prosthesis Poor Long-Term Survival in Patients With Moderate Aortic Stenosis Long-Term Outcomes of Anticoagulation for Bioprosthetic Valve Thrombosis Contemporary real-world outcomes of surgical aortic valve replacement in 141,905 low-risk, intermediate-risk, and high-risk patients Delirium After TAVR: Crosspassing the Limit of Resilience
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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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