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Treatment and clinical outcomes of transcatheter heart valve thrombosis

Azeem Latib1, Toru Naganuma2, Mohamed Abdel-Wahab2

  • 1From the Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A.L., T.N., V.F.P., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., T.N., V.F.P., A.C.); Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany (M.A.-W., G.R.); Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (H.D.); Division of Cardiology, Cardiac Catheterization Laboratories, Clinica Montevergine, Mercogliano, Italy (L.C., E.S.); Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (M.B., J.G.W.); Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany (H.B., G.K.); Interventional Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel (A.F.); Department of Cardiology, CHU de Liege, Liege, Belgium (V.L.); Department of Cardiology, Reina Sofia University Hospital, Cordoba, Spain (J.S.d.L.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Universite´ Catholique de Louvain, Brussels, Belgium (J.K.); Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France (D.M.-Z., A.V.); Deaprtment of Cardiology, St. George's Hospital, London, United Kingdom (J.-C.L.); Columbia University Medical Center and Cardiovascular Research Foundation, New York (M.B.L.); and Department of Cardiothoracic Surgery, San Raffaele Scientific Institute, Milan, Italy (F.M., O.A.). info@emocolumbus.it.

Circulation. Cardiovascular Interventions
|April 16, 2015
PubMed

Insights

Transcatheter heart valve (THV) thrombosis is rare after aortic valve implantation, typically occurring within two years. Anticoagulation effectively reduced valve gradients, even without visible thrombus.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Prosthetic Heart Valves

Background:

  • Valve thrombosis after transcatheter aortic valve implantation (TAVI) requires further investigation.
  • Understanding the prevalence, timing, and treatment of TAVI-associated thrombosis is crucial.

Purpose of the Study:

  • To determine the incidence and characteristics of transcatheter heart valve (THV) thrombosis.
  • To evaluate the effectiveness of treatment for THV thrombosis.

Main Methods:

  • A multicenter study of 4266 patients undergoing TAVI between 2008 and 2013.
  • THV thrombosis defined by dysfunction or mobile mass, diagnosed via clinical response, imaging, or pathology.
  • Echocardiography used to assess valve gradients and leaflet morphology.

Main Results:

  • The incidence of THV thrombosis was 0.61% (26 cases).
  • Median time to thrombosis was 181 days post-TAVI; dyspnea was the most common symptom.
  • Anticoagulation significantly decreased aortic valve pressure gradients in 88% of patients within two months.

Conclusions:

  • THV thrombosis is a rare complication of TAVI, usually presenting within two years with dyspnea and elevated gradients.
  • Anticoagulation is an effective treatment and should be considered even in cases without visible thrombus on echocardiography.
Abstract

Keywords:
anticoagulantsaortic valve stenosisbioprosthesisechocardiographythrombosistranscatheter aortic valve replacement

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