Neosinus and Valve Thrombosis After Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement is regarded as an effective intervention for patients with aortic stenosis and has now been extended to low-risk populations. Leaflet thrombosis is a distinct and concerning form of transcatheter aortic valve dysfunction following transcatheter aortic valve replacement. Emerging studies have consistently shown that the formation of the neosinus after transcatheter aortic valve replacement and the resulting local hemodynamic changes are closely related to the occurrence of leaflet thrombosis. However, there is currently a lack of systematic integration of this evidence. This review aims to systematically summarize 4 key aspects of neosinus thrombosis after transcatheter aortic valve replacement: the incidence of thrombosis, the anatomical and pathological remodeling of the neosinus, the mechanisms of neosinus thrombosis, and the hemodynamic determinants within the neosinus. Local hemodynamics is the dominant and modifiable factor affecting thrombosis. Future research may integrate patient-specific modeling with long-term clinical outcomes to optimize the design and surgical strategies of transcatheter heart valves.