Details

Autor(en) / Beteiligte

• Hansson, Nicolaj C., MD
• Grove, Erik L., MD, PhD
• Andersen, Henning R., MD, DMSc
• Leipsic, Jonathon, MD
• Mathiassen, Ole N., MD, PhD
• Jensen, Jesper M., MD, PhD
• Jensen, Kaare T., MD, PhD
• Blanke, Philipp, MD
• Leetmaa, Tina, MD
• Tang, Mariann, MD
• Krusell, Lars R., MD
• Klaaborg, Kaj E., MD
• Christiansen, Evald H., MD, PhD
• Terp, Kim, MD
• Terkelsen, Christian J., MD, DMSc
• Poulsen, Steen H., MD, DMSc
• Webb, John, MD
• Bøtker, Hans Erik, MD, DMSc
• Nørgaard, Bjarne L., MD, PhD

Titel

Transcatheter Aortic Heart Valve Thrombosis: Incidence, Predisposing Factors, and Clinical Implications

Ist Teil von

• Journal of the American College of Cardiology, 2016

Erscheinungsjahr

2016

Link zum Volltext

Quelle

EZB Electronic Journals Library

Beschreibungen/Notizen

• Abstract Background There is increasing focus on transcatheter heart valve (THV) thrombosis. However, there are limited data on incidence, clinical implications and predisposing factors of THV thrombosis following transcatheter aortic valve replacement (TAVR). Objectives We assessed the incidence, potential predictors, and clinical implications of THV thrombosis determined by contrast-enhanced multidetector computed tomography (MDCT) after TAVR. Methods Among 460 consecutive patients undergoing TAVR with the Edwards Sapien XT or Sapien 3 (Edwards Lifesciences, Irvine, CA, USA) valves, 405 (88%) underwent MDCT in addition to transthoracic and transesophageal echocardiography 1-3 months post-TAVR. MDCT scans were evaluated for hypo-attenuated leaflet thickening indicating THV thrombosis. Results MDCT verified THV thrombosis in 28 of 405 (7%) patients. A total of 23 patients had subclinical THV thrombosis, while 5 (18%) patients experienced clinically overt obstructive THV thrombosis. THV thrombosis risk did not differ between the Edwards Sapien XT and the Sapien 3 valves, 8% (14/173) vs. 6% (14/232) (p=0.42). The risk of THV thrombosis in patients not receiving warfarin was higher compared to patients receiving warfarin, 10.7% vs. 1.8%; RR, 95%CI: 6.09, 1.86-19.84. A larger THV was associated with an increased THV thrombosis risk (p=0.03). In multivariable analysis, 29 mm THV (RR, 95%CI: 2.89, 1.44-5.80) and no post-TAVR warfarin treatment (RR, 95%CI: 5.46, 1.68-17.7), independently predicted THV thrombosis. Treatment with warfarin effectively reverted THV thrombosis and normalized THV function in 85% of patients as documented by follow-up transesophageal echocardiography and MDCT. Conclusions The incidence of THV thrombosis in this large study was 7%. Larger THV size may predispose to THV thrombosis, whereas treatment with warfarin appears to have a protective effect. Although often subclinical, THV thrombosis may have important clinical implications.