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Long-Term Follow-Up of Hypoattenuated Leaflet Thickening After Transcatheter Aortic Valve Replacement

Manuel Hein1, Simon Schoechlin1, Undine Schulz1

  • 1Department of Cardiology and Angiology, University Heart Center, Freiburg-Bad Krozingen, Germany.

JACC. Cardiovascular Interventions
|June 9, 2022
PubMed

Insights

Early hypoattenuated leaflet thickening (HALT) after transcatheter aortic valve replacement (TAVR) does not impact long-term survival or stroke risk. However, HALT is significantly associated with symptomatic hemodynamic valve deterioration.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Imaging

Background:

  • Early hypoattenuated leaflet thickening (HALT) is a recognized complication in transcatheter aortic valve replacement (TAVR), affecting at least 10% of patients.
  • The long-term prognostic implications of HALT following TAVR remain incompletely understood, necessitating further investigation.

Purpose of the Study:

  • To evaluate the long-term risks associated with early HALT after TAVR.
  • To assess the impact of HALT on patient survival, cardiovascular mortality, cerebrovascular events, and hemodynamic valve deterioration.

Main Methods:

  • Prospective observational registry including patients who underwent TAVR between May 2012 and December 2017.
  • Post-TAVR computed tomography angiography was utilized for HALT diagnosis.
  • Outcomes including survival, cardiovascular mortality, ischemic cerebrovascular events, and symptomatic hemodynamic valve deterioration were tracked over a median follow-up of 3.25 years.

Main Results:

  • Early HALT was identified in 16.0% (115/804) of patients.
  • No significant differences in 3-year survival rates (70.1% vs. 74.0%) or cardiovascular mortality (13.2% vs. 11.3%) were observed between patients with and without HALT.
  • While HALT was not associated with increased cerebrovascular events (2.0% vs. 4.4%), it was strongly linked to symptomatic hemodynamic valve deterioration (9.4% vs. 1.5%, P < 0.001).
  • Multivariable analysis identified HALT as a significant predictor of symptomatic hemodynamic valve deterioration (HR: 6.10).

Conclusions:

  • In patients undergoing TAVR, early HALT is not associated with adverse long-term mortality or cerebrovascular outcomes.
  • A significant association exists between early HALT and the development of symptomatic hemodynamic valve deterioration, highlighting a critical area for clinical attention.
Abstract

Keywords:
computed tomography angiographyhemodynamic valve deteriorationhypoattenuated leaflet thickeningleaflet thrombosismortalitystroketranscatheter aortic valve replacement

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