Abstract
Excellent outcomes of transcatheter aortic valve replacement (TAVR) have been experienced by patients with aortic stenosis at high and intermediate risk of surgery. 1 Vahl TP Kodali SK Leon MB Transcatheter aortic valve replacement 2016: a modern-day “Through the Looking-Glass” adventure. J Am Coll Cardiol. 2016; 67: 1472-1487 Crossref PubMed Scopus (106) Google Scholar Findings from large randomised trials 1 Vahl TP Kodali SK Leon MB Transcatheter aortic valve replacement 2016: a modern-day “Through the Looking-Glass” adventure. J Am Coll Cardiol. 2016; 67: 1472-1487 Crossref PubMed Scopus (106) Google Scholar , 2 Dangas GD Weitz JL Giustino G Makkar R Mehran R Prosthetic heart valve thrombosis. J Am Coll Cardiol. 2016; 68: 2670-2689 Crossref PubMed Scopus (225) Google Scholar have shown survival with TAVR that is similar to or improved compared with bioprosthetic surgical aortic valve replacement (SAVR), and very low stroke rates have been observed with new-generation devices. Investigators of echocardiographic follow-up studies 3 Daubert MA Weissman NJ Hahn RT et al. Long-term valve performance of TAVR and SAVR: a report from the PARTNER I trial. JACC Cardiovasc Imaging. 2017; 10: 15-25 Crossref Scopus (73) Google Scholar have consistently reported low transvalvular gradients up to 5 years after TAVR and SAVR, with slightly greater aortic valve areas after TAVR than after SAVR. Against this background, the occurrence of subclinical valve leaflet thrombosis in patients, detected with CT after TAVR or SAVR, has been described. 4 Makkar RR Fontana G Jilaihawi H et al. Possible subclinical leaflet thrombosis in bioprosthetic aortic valves. N Engl J Med. 2015; 373: 2015-2024 Crossref PubMed Scopus (736) Google Scholar Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational studySubclinical leaflet thrombosis occurred frequently in bioprosthetic aortic valves, more commonly in transcatheter than in surgical valves. Anticoagulation (both NOACs and warfarin), but not dual antiplatelet therapy, was effective in prevention or treatment of subclinical leaflet thrombosis. Subclinical leaflet thrombosis was associated with increased rates of TIAs and strokes or TIAs. Despite excellent outcomes after TAVR with the new-generation valves, prevention and treatment of subclinical leaflet thrombosis might offer a potential opportunity for further improvement in valve haemodynamics and clinical outcomes. Full-Text PDF
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call