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Subclinical Leaflets Thrombosis After Transcatheter Replacement of Bicuspid vs. Tricuspid Aortic Valve

Gangjie Zhu1,2, Jiaqi Fan1, Dao Zhou1,2

  • 1Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.

Frontiers in Cardiovascular Medicine
|January 10, 2022
PubMed

Insights

Subclinical leaflet thrombosis (SLT) occurred similarly in bicuspid (BAV) and tricuspid aortic valve (TAV) patients after transcatheter aortic valve replacement (TAVR). Age and anticoagulation predicted SLT, with no significant clinical event differences observed.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Radiology

Background:

  • Subclinical leaflet thrombosis (SLT) is a critical factor impacting bioprosthetic valve durability.
  • Understanding SLT's effect in bicuspid aortic valves (BAV) is crucial for long-term outcomes.

Purpose of the Study:

  • To compare the incidence and impact of CT-defined SLT in patients with BAV versus tricuspid aortic valves (TAV) undergoing transcatheter aortic valve replacement (TAVR).
  • To identify predictors of SLT and assess clinical events in BAV and TAV populations post-TAVR.

Main Methods:

  • Retrospective analysis of 170 BAV and 201 TAV patients who underwent TAVR.
  • Multidetector computed tomography (CT) performed at 30 days and 1-year post-procedure to assess for hypoattenuated leaflet thickening (HALT), a marker for SLT.
  • Comparison of hemodynamic parameters (mean aortic gradient, effective orifice area) and clinical events between groups.

Main Results:

  • The incidence of HALT at 30 days and 1-year was comparable between BAV and TAV groups (34.9% vs. 36.7% at 1 year).
  • While mean aortic gradient was similar, effective orifice area at 1-year was significantly different (p=0.004).
  • Age and anticoagulation were identified as independent predictors of SLT at 1-year in both BAV and TAV groups. No significant difference in clinical events was noted between HALT and no-HALT groups.

Conclusions:

  • CT-defined subclinical leaflet thrombosis is comparable between BAV and TAV patients in the first year post-TAVR.
  • Age and anticoagulation status are key predictors for SLT development after TAVR.
  • No significant differences in clinical events were observed between BAV and TAV groups at the 1-year follow-up, irrespective of HALT presence.

Keywords:
bicuspid aortic valvehypoattenuated leaflet thickeningsubclinical leaflet thrombosistranscatheter aortic valve replacementtricuspid aortic valve

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