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

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• 作者：Nicolaj C. Hansson ; MD^a ; ^{nh@dadlnet.dk" class="auth_mail" title="E-mail the corresponding author} ; Erik L. Grove ; MD ; PhD^a ; ^b ; Henning R. Andersen ; MD ; DMSc^a ; Jonathon Leipsic ; MD^c ; Ole N. Mathiassen ; MD ; PhD^a ; Jesper M. Jensen ; MD ; PhD^a ; Kaare T. Jensen ; MD ; PhD^a ; Philipp Blanke ; MD^c ; Tina Leetmaa ; MD^a ; Mariann Tang ; MD^d ; Lars R. Krusell ; MD^a ; Kaj E. Klaaborg ; MD^d ; Evald H. Christiansen ; MD ; PhD^a ; Kim Terp ; MD^d ; Christian J. Terkelsen ; MD ; DMSc^a ; Steen H. Poulsen ; MD ; DMSc^a ; John Webb ; MD^c ; Hans Erik Bø ; tker ; MD ; DMSc^a ; ^b ; Bjarne L. Nø ; rgaard ; MD ; PhD^a
• 关键词：aortic stenosis ; multidetector computed tomography ; platelet aggregation inhibitors ; transcatheter aortic valve replacement ; warfarin
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：8 November 2016
• 年：2016
• 卷：68
• 期：19
• 页码：2059-2069
• 全文大小：905 K

文摘

There are limited data on the incidence, clinical implications, and predisposing factors of transcatheter heart valve (THV) thrombosis following transcatheter aortic valve replacement (TAVR).

Objectives

The authors assessed the incidence, potential predictors, and clinical implications of THV thrombosis as determined by contrast-enhanced multidetector computed tomography (MDCT) after TAVR.

Methods

Among 460 consecutive patients who underwent TAVR with the Edwards Sapien XT or Sapien 3 (Edwards Lifesciences, Irvine, California) THV, 405 (88%) underwent MDCT in addition to transthoracic and transesophageal echocardiography 1 to 3 months post-TAVR. MDCT scans were evaluated for hypoattenuated leaflet thickening that indicated THV thrombosis.

Results

MDCT verified THV thrombosis in 28 of 405 (7%) patients. A total of 23 patients had subclinical THV thrombosis, whereas 5 (18%) patients experienced clinically overt obstructive THV thrombosis. THV thrombosis risk did not differ among different generations of THVs (8% vs. 6%; p = 0.42). The risk of THV thrombosis in patients who did not receive warfarin was higher compared with patients who received warfarin (10.7% vs. 1.8%; risk ratio [RR]: 6.09; 95% confidence interval [CI]: 1.86 to 19.84). A larger THV was associated with an increased risk of THV thrombosis (p = 0.03). In multivariable analysis, a 29-mm THV (RR: 2.89; 95% CI: 1.44 to 5.80) and no post-TAVR warfarin treatment (RR: 5.46; 95% CI: 1.68 to 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

Incidence of THV thrombosis in this large study was 7%. A 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.