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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
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Leaflet immobility and thrombosis in transcatheter aortic valve replacement
Arnold C T Ng1, David R Holmes2, Michael J Mack3
1Department of Cardiology, Princess Alexandra Hospital, Brisbane, Australia.
European Heart Journal
|September 15, 2020
Summary
Transcatheter heart valve thrombosis can occur after TAVR, even on antiplatelet therapy. Multidetector computed tomography is key for diagnosis, and anticoagulation may reduce thrombosis risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Imaging
Background:
- Transcatheter aortic valve replacement (TAVR) is a rapidly growing procedure worldwide.
- Patients undergoing TAVR face higher bleeding risks, leading to antiplatelet therapy as first-line treatment.
- Subclinical transcatheter heart valve (THV) thrombosis, a precursor to leaflet dysfunction, has been observed post-TAVR.
Purpose of the Study:
- To review the incidence and diagnostic criteria for THV thrombosis.
- To discuss pathophysiological mechanisms, natural history, and clinical implications of THV thrombosis.
- To explore treatment strategies for patients with THV thrombosis.
Main Methods:
- Review of recent studies on THV thrombosis.
- Comparison of diagnostic modalities, highlighting multidetector computed tomography (MDCT) sensitivity.
- Analysis of antithrombotic therapy efficacy (antiplatelet vs. anticoagulation).
Main Results:
- THV thrombosis can occur despite dual antiplatelet therapy (aspirin and thienopyridine).
- Anticoagulation appears to be associated with a significantly lower incidence of THV thrombosis.
- MDCT demonstrates higher sensitivity than echocardiography for detecting THV thrombosis.
Conclusions:
- THV thrombosis is a recognized complication of TAVR that requires careful monitoring.
- Accurate diagnosis using MDCT is crucial for timely intervention.
- Understanding the mechanisms and optimizing antithrombotic strategies are essential for managing THV thrombosis.
Keywords:
Antiplatelet therapyAntithrombotic treatmentThrombosisTranscatheter aortic valve replacementTranscatheter heart valveMore Related Videos
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