Hashrul N Rashid1, Michael Michail1,2, Abdul R Ihdayhid1,3, Cameron Dowling1, Nancy Khav1, Sean Tan1, Jaineel Ramnarain1, James D Cameron1, Arthur Nasis1, Stephen J Nicholls1, Robert P Gooley4. 1. Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia and Monash Heart, Monash Health, Monash Heart, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia. 2. Institute of Cardiovascular Science, University College London, London, UK. 3. St Paul's Hospital, Vancouver, BC, Canada. 4. Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia and Monash Heart, Monash Health, Monash Heart, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia. robert.gooley@monashhealth.org.
Abstract
BACKGROUND: The clinical predictors and sequelae of leaflet thrombosis (LT) following transcatheter aortic valve replacement (TAVR) is still unclear. Therefore, our aim was to determine the clinical predictors and sequelae at mid-term follow-up of computed tomography (CT)-defined LT following TAVR. METHODS AND RESULTS: We performed a prospective evaluation with a 320-multislice CT following TAVR for the presence of LT, defined as hypo-attenuated leaflet thickening (HALT). Four-dimensional CT image-rendering was performed to determine the presence of reduced leaflet motion (RELM). 172 patients [89 (51.7%) male, mean age 82.8 ± 5.7 years] treated with commercially available TAVR device (Lotus 54%, CoreValve 32% and Sapien 3 14%) were included, with median CT-scan at 6.0 weeks post-TAVR. Prevalence of HALT was 14.0% (24 cases) and RELM was 9.8% (17 cases). On multivariate analysis, patients with HALT were less prescribed oral anticoagulation (OAC) (OR 9.9), received larger TAVR prostheses (OR 5.7) and higher rates of moderate-severe para-valvular regurgitation (PVR) (OR 16.3). There was no difference in clinical outcomes at a median follow-up of 2.3 years. Patients with RELM had significantly higher transvalvular gradients after discharge when compared to those without RELM. CONCLUSIONS: Absence of OAC, large TAVR prostheses and moderate-severe PVR were predictors for LT. Transvalvular gradients were higher in patients that developed RELM but not HALT. Further studies are warranted to determine the long-term impact of LT on TAVR durability. Prevalence of different sub-types of CT-defined LT (HALT and RELM) and the clinical predictors of developing LT following TAVR. CT computed tomography, HALT hypo-attenuated leaflet thickening, LT leaflet thrombosis, RELM reduced leaflet motion, TAVR transcatheter aortic valve replacement.
BACKGROUND: The clinical predictors and sequelae of leaflet thrombosis (LT) following transcatheter aortic valve replacement (TAVR) is still unclear. Therefore, our aim was to determine the clinical predictors and sequelae at mid-term follow-up of computed tomography (CT)-defined LT following TAVR. METHODS AND RESULTS: We performed a prospective evaluation with a 320-multislice CT following TAVR for the presence of LT, defined as hypo-attenuated leaflet thickening (HALT). Four-dimensional CT image-rendering was performed to determine the presence of reduced leaflet motion (RELM). 172 patients [89 (51.7%) male, mean age 82.8 ± 5.7 years] treated with commercially available TAVR device (Lotus 54%, CoreValve 32% and Sapien 3 14%) were included, with median CT-scan at 6.0 weeks post-TAVR. Prevalence of HALT was 14.0% (24 cases) and RELM was 9.8% (17 cases). On multivariate analysis, patients with HALT were less prescribed oral anticoagulation (OAC) (OR 9.9), received larger TAVR prostheses (OR 5.7) and higher rates of moderate-severe para-valvular regurgitation (PVR) (OR 16.3). There was no difference in clinical outcomes at a median follow-up of 2.3 years. Patients with RELM had significantly higher transvalvular gradients after discharge when compared to those without RELM. CONCLUSIONS: Absence of OAC, large TAVR prostheses and moderate-severe PVR were predictors for LT. Transvalvular gradients were higher in patients that developed RELM but not HALT. Further studies are warranted to determine the long-term impact of LT on TAVR durability. Prevalence of different sub-types of CT-defined LT (HALT and RELM) and the clinical predictors of developing LT following TAVR. CT computed tomography, HALT hypo-attenuated leaflet thickening, LT leaflet thrombosis, RELM reduced leaflet motion, TAVR transcatheter aortic valve replacement.
Authors: Aditya Bharadwaj; Jessica Potts; Mohamed O Mohamed; Purvi Parwani; Pooja Swamy; Juan C Lopez-Mattei; Muhammad Rashid; Chun Shing Kwok; David L Fischman; Vassilios S Vassiliou; Philip Freeman; Erin D Michos; Mamas A Mamas Journal: Eur Heart J Date: 2020-06-14 Impact factor: 29.983
Authors: Philippe Pibarot; Julien Ternacle; Wael A Jaber; Erwan Salaun; Abdellaziz Dahou; Federico M Asch; Neil J Weissman; Leonardo Rodriguez; Ke Xu; Mohamed-Salah Annabi; Ezequiel Guzzetti; Jonathan Beaudoin; Mathieu Bernier; Jonathon Leipsic; Philipp Blanke; Marie-Annick Clavel; Erin Rogers; Maria C Alu; Pamela S Douglas; Raj Makkar; D Craig Miller; Samir R Kapadia; Michael J Mack; John G Webb; Susheel K Kodali; Craig R Smith; Howard C Herrmann; Vinod H Thourani; Martin B Leon; Rebecca T Hahn Journal: J Am Coll Cardiol Date: 2020-10-20 Impact factor: 24.094