ISSN 2996-8215
International Journal of Cardiology | Vol. 12, No. 11, November 2021 | pp. 81–88
DOI: 10.46882/2021/IJC/000152
Original Research Article
Long-Term Impact of Subclinical Leaflet Thrombosis on Valve Hemodynamics After Transcatheter Aortic Valve Implantation
Jean-Pierre Dubois¹, Pierre Vigneron¹, Lucia Rossi²
¹Department of Interventional Cardiology, Hôpital Européen Georges-Pompidou, Paris, France
²Department of Cardiac Surgery, University of Milan, Milan, Italy
Abstract:
Subclinical leaflet thrombosis, characterized by hypo-attenuated leaflet thickening (HALT) on multi-detector computed tomography (MDCT), is frequently detected following transcatheter aortic valve implantation (TAVI). However, its long-term impact on transvalvular pressure gradients and clinical major adverse cardiac events (MACE) remains controversial. This prospective registry study evaluated the chronological progression of HALT and its association with late valve dysfunction. We evaluated 165 consecutive patients who underwent successful TAVI with newest-generation balloon-expandable or self-expanding bioprostheses. Four-dimensional MDCT scans were performed at 30 days post-procedure to identify HALT. Serial transthoracic echocardiography at discharge, 6 months, 12 months, and 36 months monitored mean transvalvular pressure gradients. HALT was identified in 24 patients (14.5%) at the 30-day screen. At 36 months, patients with early subclinical leaflet thrombosis demonstrated a significantly higher mean transvalvular gradient compared to those without HALT (16.4 ± 4.2 mmHg vs. 11.2 ± 3.1 mmHg, p < 0.01). Ischemia-driven target valve reintervention or stroke occurred in 16.7% of the HALT cohort versus 5.0% in the non-HALT group (p = 0.04). Multivariable logistic regression confirmed that early HALT was independently associated with a 3-year mean gradient rise greater than or equal to 5 mmHg (odds ratio: 3.42, 95% CI: 1.54–7.62, p = 0.003). Subclinical leaflet thrombosis identified early after TAVI is not benign, as it correlates with a significant rise in late transvalvular pressure gradients and an increased risk of mid-term thromboembolic events.
Keywords: Transcatheter aortic valve implantation, Hypo-attenuated leaflet thickening, Subclinical leaflet thrombosis, Computed tomography, Valve hemodynamics, Stroke
Received: August 01, 2021; Revised: September 15, 2021; Accepted: October 10, 2021; Published: November 20, 2021