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The prevalence of computed tomography-defined leaflet thrombosis in intra- versus supra-annular transcatheter aortic

Hashrul N Rashid1, Arthur Nasis1, Robert P Gooley1

  • 1Monash Cardiovascular Research Centre, MonashHEART, Monash Health, and Monash University, Clayton, Victoria, Australia.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|September 16, 2018
PubMed

Insights

Leaflet thrombosis (LT) is more common with intra-annular valves (IAV) than supra-annular valves (SAV) after transcatheter aortic valve replacement (TAVR). This finding highlights potential differences in LT prevalence based on valve design.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • Leaflet thrombosis (LT) after transcatheter aortic valve replacement (TAVR) is linked to increased cerebrovascular events.
  • The neo-sinus dimensions, influenced by valve type (intra-annular vs. supra-annular), may affect LT development.
  • Previous studies suggest a higher thrombus burden with intra-annular valves (IAV).

Purpose of the Study:

  • To systematically review and assess the prevalence of leaflet thrombosis (LT) in patients who received intra-annular valves (IAV) versus supra-annular valves (SAV) during TAVR.
  • To compare LT rates between IAV and SAV prostheses in a diverse patient cohort.

Main Methods:

  • Systematic review of published studies reporting computed tomography (CT)-defined LT following TAVR.
  • Inclusion criteria: comparison of LT and non-LT cohorts, separate registries, and full publication.
  • Analysis of 7 observational studies encompassing 1,644 patients.

Main Results:

  • The overall prevalence of LT post-TAVR was 12.8%.
  • Intra-annular valves (IAV) showed a higher prevalence of LT (13.5%) compared to supra-annular valves (SAV) (7%) (P=0.02).
  • Even excluding the Portico valve system, IAVs still demonstrated higher LT rates (12.1% vs. 7%, P=0.05).

Conclusions:

  • Intra-annular valve prostheses are associated with significantly higher rates of leaflet thrombosis compared to supra-annular valves following TAVR.
  • These findings suggest that TAVR valve design, specifically the intra-annular versus supra-annular placement, impacts LT development and potentially cerebrovascular event risk.
Abstract

Keywords:
aortic stenosisaortic valve diseaseleaflet thrombosistranscatheter aortic valve replacement

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