Haemodynamic prosthetic valve performance in patients with early leaflet thrombosis after transcatheter aortic valve implantation

Abstract

Aims

We sought to evaluate haemodynamic prosthetic valve performance in patients with early leaflet thrombosis (LT) after transcatheter aortic valve implantation (TAVI).

Method and Results

In this retrospective observational study, 59 patients with LT underwent clinical and echocardiographic follow-up. During a median follow-up of 383 days 41 patients received antiplatelet therapy (APT-group) and 18 patients oral anticoagulation due to atrial fibrillation (AC-group). The mean pressure gradient (MPG) at baseline did not differ between groups (P = 0.875). During follow-up, MPG increased from 11.0 (9.0; 14.5) to 13.0 mmHg (10.0; 18.0)_ in the APT-group (P = 0.010) but remained unchanged in the AC-group (P = 0.297) resulting in a significantly higher MPG in patients on antiplatelet therapy (P = 0.024). Similarly, change of MPG per year was significantly higher in the APT-group [1.4 (− 0.9; 7.0) vs. − 0.6 (− 2.5; 1.1), P = 0.014]. Seven (17.1%) patients in the APT-group and two(11.1%) patients in the AC-group developed MPGs of at least 20 mmHg (P = 0.558). Three patients (7.3%) in the APT- and none in the AC-group developed symptoms of obstructive thrombosis (P = 0.239). In our adjusted analysis, only lack of anticoagulation was significantly associated with change in gradients during follow-up (P = 0.012).

Conclusions

In patients with LT, antiplatelet-, but not anticoagulant therapy, was associated with significant increases in MPG, which may lead to symptomatic obstructive valve thrombosis.

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References

  1. 1.

    Pache G, Schoechlin S, Blanke P, Dorfs S, Jander N, Arepalli CD, Gick M, Buettner H-J, Leipsic J, Langer M, et al. (2015) Early hypo-attenuated leaflet thickening in balloon-expandable transcatheter aortic heart valves. Eur Heart J 37:ehv526

    Google Scholar 

  2. 2.

    Chakravarty T, Søndergaard L, Friedman J, De Backer O, Berman D, Kofoed KF, Jilaihawi H, Shiota T, Abramowitz Y, Jørgensen TH, Rami T, Israr S, Fontana G, de Knegt M, Fuchs A, Lyden P, Trento A, Bhatt DL, Leon MB, Makkar RR, Ramzy D, Cheng W, Siegel RJ, Thomson LM, Mangat G, Hariri B, Sawaya FJ, Iversen HK (2017) Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational study. The Lancet 389:2383–2392

    Article  Google Scholar 

  3. 3.

    Ruile P, Jander N, Blanke P, Schoechlin S, Reinöhl J, Gick M, Rothe J, Langer M, Leipsic J, Buettner H-J, Neumann F-J, Pache G (2017) Course of early subclinical leaflet thrombosis after transcatheter aortic valve implantation with or without oral anticoagulation. Clin Res Cardiol 106:85–96

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Makkar RR, Fontana G, Jilaihawi H, Chakravarty T, Kofoed KF, de Backer O, Asch FM, Ruiz CE, Olsen NT, Trento A, Friedman J, Berman D, Cheng W, Kashif M, Jelnin V, Kliger CA, Guo H, Pichard AD, Weissman NJ, Kapadia S, Manasse E, Bhatt DL, Leon MB, Søndergaard L (2015) Possible subclinical leaflet thrombosis in bioprosthetic aortic valves. N Engl J Med 373:2015–2024

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Hansson NC, Grove EL, Andersen HR, Leipsic J, Mathiassen ON, Jensen JM, Jensen KT, Blanke P, Leetmaa T, Tang M, Krusell LR, Klaaborg KE, Christiansen EH, Terp K, Terkelsen CJ, Poulsen SH, Webb J, Bøtker HE, Nørgaard BL (2016) Transcatheter aortic valve thrombosis: incidence, predisposing factors, and clinical implications. J Am Coll Cardiol 68:2059–2069

    Article  PubMed  Google Scholar 

  6. 6.

    Leetmaa T, Hansson NC, Leipsic J, Jensen K, Poulsen SH, Andersen HR, Jensen JM, Webb J, Blanke P, Tang M, Nørgaard BL (2015) Early aortic transcatheter heart valve thrombosis: diagnostic value of contrast-enhanced multidetector computed tomography. Circ Cardiovasc Interv 8:e001596

    Article  PubMed  Google Scholar 

  7. 7.

    Pache G, Blanke P, Zeh W, Jander N (2013) Cusp thrombosis after transcatheter aortic valve replacement detected by computed tomography and echocardiography. Eur Heart J 34:3546–3546

    Article  PubMed  Google Scholar 

  8. 8.

    Sondergaard L, De Backer O, Kofoed KF, Jilaihawi H, Fuchs A, Chakravarty T, Kashif M, Kazuno Y, Kawamori H, Maeno Y, Bieliauskas G, Guo H, Stone GW, Makkar R (2017) Natural history of subclinical leaflet thrombosis affecting motion in bioprosthetic aortic valves. Eur Heart J 38:2201–2207

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Yanagisawa R, Hayashida K, Yamada Y, Tanaka M, Yashima F, Inohara T, Arai T, Kawakami T, Maekawa Y, Tsuruta H, Itabashi Y, Murata M, Sano M, Okamoto K, Yoshitake A, Shimizu H, Jinzaki M, Fukuda K (2017) Incidence, predictors, and mid-term outcomes of possible leaflet thrombosis after TAVR. JACC Cardiovasc Imaging 10:1–11

    Article  Google Scholar 

  10. 10.

    Vollema EM, Kong WKF, Katsanos S, Kamperidis V, van Rosendael PJ, van der Kley F, de Weger A, Ajmone Marsan N, Delgado V, Bax JJ (2017) Transcatheter aortic valve thrombosis: the relation between hypo-attenuated leaflet thickening, abnormal valve haemodynamics, and stroke. Eur Heart J 38:1207–1217

    Article  PubMed  Google Scholar 

  11. 11.

    Ruile P, Minners J, Breitbart P, Schoechlin S, Gick M, Pache G, Neumann F-J, Hein M (2018) Medium-term follow-up of early leaflet thrombosis after transcatheter aortic valve replacement. JACC Cardiovasc Interv 11:1164–1171

    Article  PubMed  Google Scholar 

  12. 12.

    Capodanno D, Petronio AS, Prendergast B, Eltchaninoff H, Vahanian A, Modine T, Lancellotti P, Sondergaard L, Ludman PF, Tamburino C, Piazza N, Hancock J, Mehilli J, Byrne RA, Baumbach A, Kappetein AP, Windecker S, Bax J, Haude M (2017) Standardized definitions of structural deterioration and valve failure in assessing long-term durability of transcatheter and surgical aortic bioprosthetic valves: a consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorsed by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg 52:408–417

    Article  PubMed  Google Scholar 

  13. 13.

    Kappetein AP, Head SJ, Généreux P, Piazza N, van Mieghem NM, Blackstone EH, Brott TG, Cohen DJ, Cutlip DE, van Es G-A, Hahn RT, Kirtane AJ, Krucoff MW, Kodali S, Mack MJ, Mehran R, Rodés-Cabau J, Vranckx P, Webb JG, Windecker S, Serruys PW, Leon MB (2012) Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. Eur Heart J 33:2403–2418

    Article  PubMed  Google Scholar 

  14. 14.

    Kodali SK, Williams MR, Smith CR, Svensson LG, Webb JG, Makkar RR, Fontana GP, Dewey TM, Thourani VH, Pichard AD (2012) Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 366:1686–1695

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Mack MJ, Leon MB, Smith CR, Miller DC, Moses JW, Tuzcu EM, Webb JG, Douglas PS, Anderson WN, Blackstone EH, Kodali SK, Makkar RR, Fontana GP, Kapadia S, Bavaria J, Hahn RT, Thourani VH, Babaliaros V, Pichard A, Herrmann HC, Brown DL, Williams M, Davidson MJ, Svensson LG, Akin J (2015) 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. The Lancet 385:2477–2484

    Article  Google Scholar 

  16. 16.

    Del Trigo M, Muñoz-Garcia AJ, Wijeysundera HC, Nombela-Franco L, Cheema AN, Gutierrez E, Serra V, Kefer J, Amat-Santos IJ, Benitez LM, Mewa J, Jiménez-Quevedo P, Alnasser S, Garcia del Blanco B, Dager A, Abdul-Jawad Altisent O, Puri R, Campelo-Parada F, Dahou A, Paradis J-M, Dumont E, Pibarot P, Rodés-Cabau J (2016) Incidence, timing, and predictors of valve hemodynamic deterioration after transcatheter aortic valve replacement. J Am Coll Cardiol 67:644–655

    Article  PubMed  Google Scholar 

  17. 17.

    Mara Vollema E, Kong WK, Katsanos S, Kamperidis V, Rosendael P, Kley F, de Weger A, Aimone N, Delgado V, Bax JJ (2017) Transcatheter aortic valve thrombosis: the relation between hypo-attenuated leaflet thickening, abnormal valve hemodynamics and stroke. Eur Heart J 38:1207–1217

    Article  PubMed  Google Scholar 

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Correspondence to Manuel Hein.

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Conflict of interest

Dr. Pache: consultant for Edwards Lifesciences Inc. The other authors have no conflicts of interest to declare.

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Hein, M., Minners, J., Jander, N. et al. Haemodynamic prosthetic valve performance in patients with early leaflet thrombosis after transcatheter aortic valve implantation. Clin Res Cardiol 108, 1017–1024 (2019). https://doi.org/10.1007/s00392-019-01429-7

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Keywords

  • Transcatheter aortic valve implantation (TAVI)
  • Aortic stenosis
  • Leaflet thrombosis
  • Hypo-attenuated leaflet thickening
  • Echocardiography