Frequency, Predictors, and Clinical Impact of Valvular and Perivalvular Thrombus After Transcatheter Aortic Valve Replacement
Journal
JACC. Cardiovascular interventions
Journal Volume
16
Journal Issue
24
Pages
2967-2981
Date Issued
2023-12-25
Author(s)
Choi, Yeonwoo
Ahn, Jung-Min
Kang, Do-Yoon
Kim, Hwa Jung
Kim, Hoyun
Lee, Jinho
Kim, Mijin
Park, Jinsun
Kim, Kyung Won
Koo, Hyun Jung
Yang, Dong Hyun
Jung, Seung Chai
Kim, Byungjun
Anthony Wong, Yiu Tung
Simon Lam, Cheung Chi
Yin, Wei-Hsian
Wei Jeng
Lee, Yung-Tsai
Kim, Won-Jang
Kang, Se Hun
Lee, Seung-Ah
Kim, Dae-Hee
Lee, Jae-Hong
Park, Seung-Jung
Park, Duk-Woo
Abstract
Background: Subclinical aortic valve complex (valvular and perivalvular) thrombus is not rare after transcatheter aortic valve replacement (TAVR). The risk factors and clinical implications of these findings remain uncertain. Objectives: This study sought to evaluate the frequency, predictors, and clinical outcome of aortic valve complex thrombus after TAVR. Methods: In the ADAPT-TAVR (Anticoagulation Versus Dual Antiplatelet Therapy for Prevention of Leaflet Thrombosis and Cerebral Embolization After Transcatheter Aortic Valve Replacement) trial comparing edoxaban vs dual antiplatelet therapy in TAVR patients without an indication for chronic anticoagulation, the frequency of valvular (subclinical leaflet thrombus) and perivalvular (supravalvular, subvalvular, and sinus of Valsalva) thrombus was evaluated by 4-dimensional computed tomography at 6 months. The association of these phenomena with new cerebral thromboembolism on brain magnetic resonance imaging, neurologic and neurocognitive dysfunction, and clinical outcomes was assessed. Results: Among 211 patients with 6-month computed tomography evaluations, 91 patients (43.1%) had thrombus at any aortic valve complex, 30 (14.2%) patients had leaflet thrombus, and 78 (37.0%) patients had perivalvular thrombus. A small maximum diameter of the stent at the valve level and low body surface area were independent predictors of aortic valve complex and perivalvular thrombus, and decreased renal function was an independent predictor of leaflet thrombus. No significant differences were observed in new cerebral lesions, neurologic or neurocognitive functions, or clinical outcomes among patients with or without valvular or perivalvular thrombus. Conclusions: Subclinical aortic valve complex (valvular and perivalvular) thrombus was common in patients who had undergone successful TAVR. However, these imaging phenomena were not associated with new cerebral thromboembolism, neurologic or neurocognitive dysfunction, or adverse clinical outcomes. (Anticoagulation Versus Dual Antiplatelet Therapy for Prevention of Leaflet Thrombosis and Cerebral Embolization After Transcatheter Aortic Valve Replacement [ADAPT-TAVR]; NCT03284827) © 2023 American College of Cardiology Foundation
Subjects
cerebral thromboembolism; thrombus; transcatheter aortic valve replacement
SDGs
Type
journal article