Transcatheter aortic valve replacement (TAVR) in low-risk patients has been shown to be superior or noninferior in randomized studies, but the presence of valvular thrombosis, in its different forms, has not been well analyzed, nor is there much information on its impact on evolution.
Researchers conducted an analysis of the LTR study that included 200 patients, where evolution of subclinical thrombosis was observed at 30 days.
The analysis included a 4-year follow-up of 177 patients.
The mean age was 74 years, most patients were men, 30% had diabetes, 85% had hypertension, 8% had chronic obstructive pulmonary disease (COPD), 9.5% had experienced a stroke, 21% had undergone coronary angioplasty (CTA), 1% had undergone myocardial revascularization surgery (MRS), 32.5% had a previous permanent pacemaker implantation, and 6% had suffered a prior infarction. Ejection fraction was preserved, aortic valve area (AVAo) was 0.75, and mean gradient was 47.5 mmHg.
The Society of Thoracic Surgeons (STS) mortality score was 1.8%.
The procedure was performed via transfemoral access in all patients; 75.5% of patients went under anesthetic sedation, and balloon-expandable valves were used in 88% of cases.
At 30 days, 14% of the patients experienced HALT; only 5 were treated using anticoagulants.
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At the 4-year follow-up, there were no differences between patients who did not experience HALT in mean gradient and AVAo (14.94±5.01 mmHg vs. 12.3±5.57 mmHg; p = 0.23 and 1.64±0.6 cm2 vs. 1.7±0.52 cm2; p = 0.81, respectively). There were also no differences in moderate structural deterioration (5.8%) nor in hemodynamic deterioration (1.5%), and no patients presented severe structural deterioration. Ejection fraction was similar in both groups and just one patient with HALT suffered a stroke.
Between the second and fourth year, all-cause mortality was 11.9%, cardiovascular mortality was 3.3%, and there were no differences between groups.
Conclusion
TAVR in symptomatic low-risk patients with severe aortic stenosis in the tricuspid valve was safe and durable at 4 years. Structural damage was low, regardless of valve type, and HALT presence at 30 days had no impact on structural damage, hemodynamic profile of the valve, or stroke rates at 4 years.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: Transcatheter Aortic Valve Replacement and Impact of Subclinical Leaflet Thrombosis in Low- Risk Patients: LRT Trial 4-Year Outcomes
Reference: Circ Cardiovasc Interv. 2023;16:e012655. DOI: 10.1161/CIRCINTERVENTIONS.122.012655.
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