TY - JOUR
T1 - Treatment and Clinical Outcomes of Transcatheter Heart Valve Thrombosis
AU - Latib, Azeem
AU - Naganuma, Toru
AU - Abdel-Wahab, Mohamed
AU - Danenberg, Haim
AU - Cota, Linda
AU - Barbanti, Marco
AU - Baumgartner, Helmut
AU - Finkelstein, Ariel
AU - LeGrand, Victor
AU - De Lezo, José Suárez
AU - Kefer, Joelle
AU - Messika-Zeitoun, David
AU - Richardt, Gert
AU - Stabile, Eugenio
AU - Kaleschke, Gerrit
AU - Vahanian, Alec
AU - Laborde, Jean Claude
AU - Leon, Martin B.
AU - Webb, John G.
AU - Panoulas, Vasileios F.
AU - Maisano, Francesco
AU - Alfieri, Ottavio
AU - Colombo, Antonio
N1 - Publisher Copyright:
© © 2015 American Heart Association, Inc.
PY - 2015/4/21
Y1 - 2015/4/21
N2 - Background - Valve thrombosis has yet to be fully evaluated after transcatheter aortic valve implantation. This study aimed to report the prevalence, timing, and treatment of transcatheter heart valve (THV) thrombosis. Methods and Results - THV thrombosis was defined as follows (1) THV dysfunction secondary to thrombosis diagnosed based on response to anticoagulation therapy, imaging modality or histopathology findings, or (2) mobile mass detected on THV suspicious of thrombus, irrespective of dysfunction and in absence of infection. Between January 2008 and September 2013, 26 (0.61%) THV thromboses were reported out of 4266 patients undergoing transcatheter aortic valve implantation in 12 centers. Of the 26 cases detected, 20 were detected in the Edwards Sapien/Sapien XT cohort and 6 in the Medtronic CoreValve cohort. In patients diagnosed with THV thrombosis, the median time to THV thrombosis post-transcatheter aortic valve implantation was 181 days (interquartile range, 45-313). The most common clinical presentation was exertional dyspnea (n=17; 65%), whereas 8 (31%) patients had no worsening symptoms. Echocardiographic findings included a markedly elevated mean aortic valve pressure gradient (40.5±14.0 mm Hg), presence of thickened leaflets or thrombotic apposition of leaflets in 20 (77%) and a thrombotic mass on the leaflets in the remaining 6 (23%) patients. In 23 (88%) patients, anticoagulation resulted in a significant decrease of the aortic valve pressure gradient within 2 months. Conclusions - THV thrombosis is a rare phenomenon that was detected within the first 2 years after transcatheter aortic valve implantation and usually presented with dyspnea and increased gradients. Anticoagulation seems to have been effective and should be considered even in patients without visible thrombus on echocardiography.
AB - Background - Valve thrombosis has yet to be fully evaluated after transcatheter aortic valve implantation. This study aimed to report the prevalence, timing, and treatment of transcatheter heart valve (THV) thrombosis. Methods and Results - THV thrombosis was defined as follows (1) THV dysfunction secondary to thrombosis diagnosed based on response to anticoagulation therapy, imaging modality or histopathology findings, or (2) mobile mass detected on THV suspicious of thrombus, irrespective of dysfunction and in absence of infection. Between January 2008 and September 2013, 26 (0.61%) THV thromboses were reported out of 4266 patients undergoing transcatheter aortic valve implantation in 12 centers. Of the 26 cases detected, 20 were detected in the Edwards Sapien/Sapien XT cohort and 6 in the Medtronic CoreValve cohort. In patients diagnosed with THV thrombosis, the median time to THV thrombosis post-transcatheter aortic valve implantation was 181 days (interquartile range, 45-313). The most common clinical presentation was exertional dyspnea (n=17; 65%), whereas 8 (31%) patients had no worsening symptoms. Echocardiographic findings included a markedly elevated mean aortic valve pressure gradient (40.5±14.0 mm Hg), presence of thickened leaflets or thrombotic apposition of leaflets in 20 (77%) and a thrombotic mass on the leaflets in the remaining 6 (23%) patients. In 23 (88%) patients, anticoagulation resulted in a significant decrease of the aortic valve pressure gradient within 2 months. Conclusions - THV thrombosis is a rare phenomenon that was detected within the first 2 years after transcatheter aortic valve implantation and usually presented with dyspnea and increased gradients. Anticoagulation seems to have been effective and should be considered even in patients without visible thrombus on echocardiography.
KW - anticoagulants
KW - aortic valve stenosis
KW - bioprosthesis
KW - echocardiography
KW - thrombosis
KW - transcatheter aortic valve replacement
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U2 - 10.1161/CIRCINTERVENTIONS.114.001779
DO - 10.1161/CIRCINTERVENTIONS.114.001779
M3 - Article
C2 - 25873727
AN - SCOPUS:84937401574
SN - 1941-7640
VL - 8
JO - Circulation: Cardiovascular Interventions
JF - Circulation: Cardiovascular Interventions
IS - 4
M1 - e001779
ER -