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Published on: February 4, 2021
Subclinical Leaflet Thrombosis and Subclinical Aortic Valve Complex Thrombosis in TAVR
Benjamin Marchandot1, Antonin Trimaille1, Shinnosuke Kikuchi2
1Department of Cardiology, University Hospital of Strasbourg, Strasbourg, France; Research Unit - UR3074 - Translational Cardiovascular Medicine, University of Strasbourg, Strasbourg, France; GERCA (Groupe pour l'Enseignement et la Recherche Cardiologique en Alsace), Strasbourg, France.
Abstract:
Subclinical leaflet thrombosis (SLT) following transcatheter aortic valve replacement occurs in 10% to 15% of patients at 1 month and up to 30% by 1 year, extending to perivalvular structures as subclinical aortic valve-complex thrombosis. We review contributing factors to SLT, including valve-specific parameters such as flow dynamics in the native sinus and neosinus, prosthesis sizing, deployment symmetry, implant depth, and commissural alignment; the persistent metabolic activity of retained calcified leaflets; and the impact of antithrombotic therapy on SLT incidence. Although oral anticoagulation reduces imaging-detected SLT, it increases bleeding and mortality. This review offers a comprehensive analysis integrating device geometry, sinus flow dynamics, and native tissue activity to inform personalized, time-limited anticoagulation strategies in high-risk patients, thereby optimizing the thrombosis-bleeding balance and enhancing transcatheter aortic valve replacement outcomes.
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