Hypoattenuated lesion; Multi-detector computed tomography; Subclinical leaflet thrombosis; Transcatheter aortic valve replacement; Cardiology and Cardiovascular Medicine; Surgery
Abstract :
[en] [en] AIMS: Subclinical thrombosis may represent an early stage of prosthesis structural disease. Most of the available evidence on the incidence, location, predictors, and consequences of thrombosis comes from studies that have employed balloon-expandable valves. We aimed to describe the different localisations of valvular and perivalvular thrombosis and analyse prosthesis-host multi-detector computed tomography predictors in the context of self-expandable prosthesis. Additionally, we aimed to assess the impact of valvular and perivalvular thrombosis on prosthesis performance and subsequent clinical outcomes.
METHODS AND RESULTS: This analysis includes 100 consecutive patients with normal renal function who underwent transcatheter aortic valve replacement using Evolut R and received multi-detector computed tomography and transthoracic bi-dimensional echocardiography at the 6 month follow-up. Leaflet thrombosis was detected in 18 (18%) patients; 6 (6%) had at least one leaflet with severe thrombosis. Thrombosis of the anatomic sinus was detected in 24 patients (24%) and was more prevalent in the non-coronary sinus. Subvalvular thrombosis with partial or complete circumferential involvement of the prosthesis inner skirt was diagnosed in 23 patients (23%). Bicuspid valve was the predictor with highest association with hypoattenuated lesions [least absolute shrinkage and selection operator coefficient 0.35, 95%, confidence interval (CI) 0.21-0.68]. There was no difference in terms of haemodynamic structural valve dysfunction, neurological events, and re-hospitalisation between the groups with and without thrombosis (hazard ratio: 0.86, 95% CI: 0.24-3.06, P = 0.82).
CONCLUSION: This study showed that in a relatively low-risk population, valvular and perivalvular thrombosis were not rare phenomena following transcatheter aortic valve replacement at early follow-up. Bicuspid valve showed the strongest association with post-implant thrombosis.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Moscarelli, Marco ; Department of Cardiovascular Surgery, Maria Eleonora Hospital, Viale della Regione Siciliana Nord Ovest, 1571, 90135 Palermo PA, Italy ; Department of Surgery & Cancer, Faculty of Medicine, Hammersmith Hospital, 72 Du Cane Rd, London W12 0HS, UK
Zaccone, Gregorio; Department of Cardiovascular Surgery, Maria Eleonora Hospital, Viale della Regione Siciliana Nord Ovest, 1571, 90135 Palermo PA, Italy
Zlahoda-Huzior, Adriana; Department of Measurement and Electronics AGH University of Krakow, Poland, al. A. Mickiewicza 30 / B1 30-059 Kraków ; SimHub, VIRMED Sp. z o. o.Ul. Miechowska 5B / 1, 30-055 Kraków, Polska NIP 6772492319
Pernice, Vincenzo; Department of Cardiovascular Surgery, Maria Eleonora Hospital, Viale della Regione Siciliana Nord Ovest, 1571, 90135 Palermo PA, Italy
Milo, Sabrina; Department of Radiology, Maria Eleonora Hospital, Viale della Regione Siciliana Nord Ovest, 1571, 90135 Palermo PA, Italy
Violante, Francesco; Department of Radiology, Maria Eleonora Hospital, Viale della Regione Siciliana Nord Ovest, 1571, 90135 Palermo PA, Italy
Trizzino, Francesca; Department of Cardiovascular Surgery, Maria Eleonora Hospital, Viale della Regione Siciliana Nord Ovest, 1571, 90135 Palermo PA, Italy
Dudek, Dariusz; Jagiellonian University Medical College, Świętej Anny 12, 31-008 Kraków, Poland
Speziale, Giuseppe; Department of Cardiovascular Surgery, Anthea Hospital, GVM Care & Research, Via Camillo Rosalba, 35/37, 70124 Bari BA, Italy
Lancellotti, Patrizio ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation ; Département des sciences cliniques, Cardiologie-Pathologies spéciales et réhabilitation, GIGA Institute, B36 Quartier Hôpital 4000 Liège, Belgique
Fattouch, Khalil ; Kore University, Faculty of Medicine, Piazza dell'Università, 94100 Enna EN, Italy
Language :
English
Title :
Valvular and perivalvular thrombosis following self-expandable aortic valve replacement: analysis of 100 multi-detector computed tomography scans.
Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W, Neumann F-J, Myers P, Abdelhamid M, Achenbach S, Asteggiano R, Barili F, Borger MA, Carrel T, Collet J-P, Foldager D, Habib G, Hassager C, Irs A, Iung B, Jahangiri M, Katus HA, Koskinas KC, Massberg S, Mueller CE, Nielsen JC, Pibarot P, Rakisheva A, Roffi M, Rubboli A, Shlyakhto E, Siepe M, Sitges M, Sondergaard L, Sousa-Uva M, Tarantini G, Zamorano JL, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W, Benchabi Y, Chilingaryan A, Metzler B, Rustamova Y, Shumavets V, Lancellotti P, Smajic E, Trendafilova-Lazarova D, Samardzic J, Karakyriou M, Palecek T, Sanchez Dahl J, Meshaal MS, Palm K, Virtanen M, Bouleti C, Bakhutashvili Z, Achenbach S, Boutsikou M, Kertész AB, Danielsen R, Topilsky Y, Golino P, Tuleutayev R, Elezi S, Kerimkulov A, Rudzitis A, Glaveckaite S, Sow R, Demarco DC, Bulatovic N, Aouad A, van den Brink R, Antova E, Beitnes JO, Ochala A, Ribeiras R, Vinereanu D, Irtyuga O, Ivanovic B, Simkova I, González Gómez A, Sarno G, Pedrazzini GB, Bsata W, Zakhama L, Korkmaz L, Cherniuk S, Khanji MY, Sharipov I. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2022;43:561-632.
Mack MJ, Leon MB, Thourani VH, Pibarot P, Hahn RT, Genereux P, Kodali SK, Kapadia SR, Cohen DJ, Pocock SJ, Lu M, White R, Szerlip M, Ternacle J, Malaisrie SC, Herrmann HC, Szeto WY, Russo MJ, Babaliaros V, Smith CR, Blanke P, Webb JG, Makkar R. Transcatheter aortic-valve replacement in low-risk patients at five years. N Engl J Med 2023;389:1949-1960.
Thyregod HGH, Jorgensen TH, Ihlemann N, Steinbruchel DA, Nissen H, Kjeldsen BJ, Petursson P, De Backer O, Olsen PS, Søndergaard L. Transcatheter or surgical aortic valve implantation: 10-year outcomes of the NOTION trial. Eur Heart J 2024;45: 1116-1124. 4.Choi Y, Ahn JM, Kang DY, Kim HJ, Kim H, Lee J, Kim M, Park J, Kim KW, Koo HJ, Yang DH, Jung SC, Kim B, Anthony Wong YT, Simon Lam CC, Yin W-H, Wei J, Lee Y-T, Kao H-L, Lin M-S, Ko T-Y, Kim W-J, Kang SH, Lee S-A, Kim D-H, Lee J-H, Park S-J, Park D-W. Frequency, predictors, and clinical impact of valvular and perivalvular thrombus after transcatheter aortic valve replacement. JACC Cardiovasc Interv 2023; 16:2967-2981.
Koo HJ, Choe J, Kang DY, Ko E, Ahn JM, Park DW, Park S-J, Kim HJ, Kim JB, Choo SJ, Kang J-W, Yang DH. Computed tomography features of cuspal thrombosis and subvalvular tissue ingrowth after transcatheter aortic valve implantation. Am J Cardiol 2020;125:597-606.
Moscarelli M, Sollami G, Lentini E, Prestera R, Pernice V, Milo S, Violante F, Cuffari F, Di Pasquale C, Ferlisi A, La Grutta L, Grassedonio E, Speziale G, Fattouch K. About different localization of hypoattenuated lesions following transcatheter aortic valve replacement. Int J Cardiol 2024;398:131597.
Cahill TJ, Kirtane AJ, Leon M, Kodali SK. Subclinical leaflet thrombosis and anticoagulation after transcatheter aortic valve replacement: a review. JAMA Cardiol 2022;7:866-872.
Fukui M, Bapat VN, Garcia S, Dworak MW, Hashimoto G, Sato H, Gössl M, Enriquez-Sarano M, Lesser JR, Cavalcante JL, Sorajja P. Deformation of transcatheter aortic valve prostheses: implications for hypoattenuating leaflet thickening and clinical outcomes. Circulation 2022;146:480-493.
Varc-3 Writing C, Genereux P, Piazza N, Alu MC, Nazif T, Hahn RT, Pibarot P, Bax JJ, Leipsic JA, Blanke P, Blackstone EH, Finn MT, Kapadia S, Linke A, Mack MJ, Makkar R, Mehran R, Popma JJ, Reardon M, Rodes-Cabau J, Van Mieghem NM, Webb JG, Cohen DJ, Leon MB. Valve Academic Research Consortium 3: updated endpoint definitions for aortic valve clinical research. J Am Coll Cardiol 2021;77:2717-2746.
Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M. Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Epidemiology 2007;18:805-835.
Jilaihawi H, Asch FM, Manasse E, Ruiz CE, Jelnin V, Kashif M, Kawamori H, Maeno Y, Kazuno Y, Takahashi N, Olson R, Alkhatib J, Berman D, Friedman J, Gellada N, Chakravarty T, Makkar RR. Systematic CT methodology for the evaluation of subclinical leaflet thrombosis. JACC Cardiovasc Imaging 2017;10:461-470.
Blanke P, Leipsic JA, Popma JJ, Yakubov SJ, Deeb GM, Gada H, Mumtaz M, Ramlawi B, Kleiman NS, Sorajja P, Askew J, Meduri CU, Kauten J, Melnitchouk S, Inglessis I, Huang J, Boulware M, Reardon MJ. Bioprosthetic aortic valve leaflet thickening in the evolut low risk sub-study. J Am Coll Cardiol 2020;75:2430-2442.
Tang GHL, Amat-Santos IJ, De Backer O, Avvedimento M, Redondo A, Barbanti M, Costa G, Tchétché D, Eltchaninoff H, Kim W-K, Zaid S, Tarantini G, Søndergaard L. Rationale, definitions, techniques, and outcomes of commissural alignment in TAVR: from the ALIGN-TAVR consortium. JACC Cardiovasc Interv 2022;15: 1497-1518.
Fuchs A, De Backer O, Brooks M, de Knegt MC, Bieliauskas G, Yamamoto M, Yanagisawa R, Hayashida K, Søndergaard L, Kofoed K. Subclinical leaflet thickening and stent frame geometry in self-expanding transcatheter heart valves. EuroIntervention 2017;13:e1067-e1075.
Rashid HN, Michail M, Ihdayhid AR, Khav N, Tan S, Nasis A, Nicholls SJ, Cameron JD, Gooley RP. Prosthesis geometrical predictors of leaflet thrombosis following transcatheter aortic valve replacement with intra-annular prostheses. Heart Lung Circ 2022;31: 678-684.
Kalra A, Das R, Alkhalil M, Dykun I, Candreva A, Jarral O, Rehman SM, Majmundar M, Patel KN, Rodes-Cabau J, Reardon MJ, Puri R. Bicuspid aortic valve disease: classifications, treatments, and emerging transcatheter paradigms. Struct Heart 2024;8: 100227.
Medtronic, data on file. 60 day porcine research study model. www.medtronic.com.
Barker AJ, Markl M, Burk J, Lorenz R, Bock J, Bauer S, Schulz-Menger J, von Knobelsdorff-Brenkenhoff F. Bicuspid aortic valve is associated with altered wall shear stress in the ascending aorta. Circ Cardiovasc Imaging 2012;5:457-466.
Moscarelli M, Sollami G, Lentini E, Prestera R, Pernice V, Violante F, Cuffari F, Pasquale CD, La Grutta L, Grassedonio E, Speziale G, Fattouch K. Self-expandable prosthesis valve adaptation: non-uniform expansion and stent frame decoupling. Am J Cardiol 2023;207:93-99.
