Valve Thrombosis After TAVR: Larger-Diameter Valves and No Warfarin as Predictors

Valve Thrombosis After TAVRThere are limited data on the incidence, clinical implications, and predisposing factors of valve thrombosis in patients who underwent transcatheter aortic valve replacement (TAVR). This study aimed at determining such information through multislice computed tomography (CT).

 

This trial included 460 consecutive patients who underwent TAVR with a balloon-expandable Edwards Sapien XT or Sapien 3 (Edwards Lifesciences, Irvine, California) device.

 

Of those, 405 patients were assessed through multislice CT in addition to transthoracic or transesophageal echocardiography 1 to 3 months after TAVR. CT scans were evaluated for hypodense thickening matching valve thrombosis.

 

The CT confirmed signs of valve thrombosis in 28 patients (7%), 23 of which were completely asymptomatic. The remaining 5 patients presented symptoms indicating obstructive valve thrombosis.

 

Valve thrombosis risk did not differ among different generations of devices, but it was more frequent in patients who did not receive warfarin when compared with anticoagulated patients (10.7% vs. 1.8%; risk ratio [RR]: 6.09; 95% confidence interval [CI]: 1.86 to 19.84). Larger-diameter valves were associated with an increased risk of thrombosis (p = 0.03).

 

In a multivariable analysis, 29-mm devices (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) were independent predictors of thrombosis.

 

Treatment with warfarin effectively reverted valve thrombosis in 85% of patients, as shown by follow-up transesophageal echocardiography and multislice computed tomography.

 

Conclusion

Incidence of valve thrombosis after transcatheter aortic valve replacement in this study was 7%. Larger-diameter valves showed higher predisposition to thrombosis, whereas warfarin treatment had a protective effect. Although most patients did not present symptoms, the clinical implications of valve thrombosis may be important.

 

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

Reference: Nicolaj C. Hansson et al. J Am Coll Cardiol. 2016;68(19):2059-2069.

 


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

Evolution of Small Balloon-Expandable Valves

Small aortic rings (20 mm) have posed a significant challenge for both surgery and transcatheter aortic valve implantation (TAVI) due to their association with an...

TCT 2024 | Asymptomatic Severe Aortic Stenosis: What Should Be our Approach?

Approximately 3% of the population over 65 years old has aortic stenosis. Current guidelines recommend valve replacement for patients with symptoms or an ejection...

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Evolution of Small Balloon-Expandable Valves

Small aortic rings (20 mm) have posed a significant challenge for both surgery and transcatheter aortic valve implantation (TAVI) due to their association with an...

TCT 2024 | Asymptomatic Severe Aortic Stenosis: What Should Be our Approach?

Approximately 3% of the population over 65 years old has aortic stenosis. Current guidelines recommend valve replacement for patients with symptoms or an ejection...

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...