Abstract
Transcatheter aortic valve implantation (TAVI) is a recent revolutionary treatment for high-risk patients with severe aortic stenosis who are not suitable for surgery, expanding to intermediate and low-risk patients. Valve leaflet thrombosis (LT) is a potentially fatal complication after TAVI. The incidence of subclinical LT is as high as 25% among patients in the first year after TAVI. Subclinical LT may evolve into symptomatic thrombosis or lead to premature bioprosthesis degeneration, increasing the risk of neurological complications. Because imaging-based methods have limited sensitivity to detect subclinical LT, there is an urgent need for predictors and biomarkers that would make it possible to predict LT after TAVI. Here, we summarize recent data regarding (i) patient-related, (ii) procedure-related, (iii) blood-based and (iv) imaging predictors and biomarkers which might be useful for the early diagnosis of subclinical LT after TAVI. Prevention of LT might offer an opportunity to improve risk stratification and tailor therapy after TAVI.
Highlights
Aortic stenosis (AS) is the most common valvular heart disease in Europe and North America, with increasing prevalence due to the aging of the population
In the recent PARTNER 3 (The Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low-Risk Patients With Aortic Stenosis) CT substudy, where 435 patients with low-surgical-risk aortic stenosis were randomized to transcatheter aortic valve implantation (TAVI) (n = 221) or surgical aortic valve replacement (SAVR) (n = 214), the incidence of hypo-attenuating leaflet thickening (HALT) increased from 10% at 30 days to 24% at one year [10]
Subclinical leaflet thrombosis (LT) is usually detected on multidetector computed tomography (MDCT) imaging as a HALT, which is a thin layer of thrombus covering one or more leaflets of the aortic valve [9]
Summary
Aortic stenosis (AS) is the most common valvular heart disease in Europe and North America, with increasing prevalence due to the aging of the population. In the recent PARTNER 3 (The Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low-Risk Patients With Aortic Stenosis) CT substudy, where 435 patients with low-surgical-risk aortic stenosis were randomized to TAVI (n = 221) or SAVR (n = 214), the incidence of HALT increased from 10% at 30 days to 24% at one year [10]. We summarize recent data regarding (i) patient-related, (ii) procedure-related, (iii) blood-based, and (iv) imaging predictors and biomarkers which might potentially be useful to predict and/or diagnose subclinical LT after TAVI.
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