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Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
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Long-Term Impact of Early Subclinical Leaflet Thrombosis After Transcatheter Aortic Valve Implantation

Juri Iwata1, Kentaro Hayashida1, Ryo Arita1

  • 1Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|February 3, 2025
PubMed

Insights

Hypoattenuated leaflet thickening (HALT) after transcatheter aortic valve implantation (TAVI) is not linked to long-term adverse clinical outcomes or valve deterioration. Early detection of HALT using multidetector computed tomography (MDCT) does not impact patient prognosis post-TAVI.

Area of Science:

  • Cardiology
  • Radiology
  • Biomedical Engineering

Background:

  • Hypoattenuated leaflet thickening (HALT) on multidetector computed tomography (MDCT) after transcatheter aortic valve implantation (TAVI) is often presumed to be leaflet thrombosis.
  • The long-term clinical implications of early HALT detection remain uncertain.

Purpose of the Study:

  • To evaluate the impact of early HALT detection on long-term clinical outcomes and structural valve deterioration following TAVI.
  • To assess the association between HALT and hemodynamic performance over a 6-year period.

Main Methods:

  • A cohort of 448 patients receiving SAPIEN XT or SAPIEN 3 valves underwent MDCT within 30 days post-TAVI.
  • Annual echocardiographic data and MDCT results were analyzed for up to 6 years.
  • Clinical outcomes including mortality, stroke, heart failure rehospitalization, and structural valve deterioration were compared between HALT and non-HALT groups.

Main Results:

  • HALT was identified in 15.2% of eligible patients within 30 days of TAVI.
  • No significant differences in effective orifice area were observed between HALT and non-HALT groups at 30 days post-TAVI for either valve type.
  • Long-term follow-up (median 1872 days) revealed no significant differences in all-cause mortality, stroke incidence, heart failure rehospitalization, or structural valve deterioration between groups.

Conclusions:

  • Early detection of HALT within 30 days after TAVI is not associated with adverse long-term clinical outcomes.
  • HALT does not appear to significantly affect hemodynamic performance or lead to increased structural valve deterioration in the long term.
Abstract

Keywords:
balloon‐expandable valvehypoattenuated leaflet thickeninglong‐termstructural valve deteriorationtranscatheter aortic valve implantation

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