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Valve Thrombosis Following Transcatheter Aortic Valve Replacement: State-of-the-Art Review
Fabiana Duarte1, Inês Aguiar-Neves2, Cláudio Espada Guerreiro2
1Cardiology Department, Hospital of Divino Espírito Santo, Ponta Delgada, Portugal.
Summary
Transcatheter aortic valve replacement (TAVR) can lead to leaflet thrombosis in 5-40% of cases, often subclinical. Management strategies for TAV thrombosis require further research to balance risks and benefits.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomaterials Science
Background:
- Transcatheter aortic valve replacement (TAVR) is a key treatment for severe aortic stenosis.
- Transcatheter aortic valves (TAV) have a lower thrombogenic profile than mechanical valves but are still susceptible to thrombosis (5-40% incidence).
- Subclinical TAV thrombosis is detectable by cardiac computed tomography (CCT) in asymptomatic patients.
Purpose of the Study:
- To comprehensively review current data on TAVR-associated thrombosis.
- To elucidate the incidence, mechanisms, diagnosis, and management of TAV thrombosis.
- To discuss preventive measures and long-term follow-up strategies for TAV thrombosis.
Main Methods:
- Literature review of studies on TAVR and TAV thrombosis.
- Analysis of diagnostic modalities including CCT and echocardiography.
- Synthesis of data on antithrombotic therapy and clinical outcomes.
Main Results:
- TAV thrombosis occurs in 5-40% of cases, frequently subclinical and detected by CCT.
- Mechanisms involve mechanical, patient, device, and procedural factors.
- Optimal antithrombotic therapy and the benefit of anticoagulation in subclinical cases remain under investigation.
Conclusions:
- TAV thrombosis is a significant complication requiring further research into optimal management.
- The role of routine CCT and the efficacy of anticoagulation for subclinical thrombosis need clarification.
- Balancing bleeding risk with antithrombotic benefits is crucial for post-TAVR patients.
Keywords:
anticoagulation therapycardiac computed tomographyelevated transprosthetic gradientsthrombosistranscatheter aortic valve replacementMore Related Videos
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