Abstract
Hypo-attenuated leaflet thickening (HALT) is gaining attention as a relatively common issue after surgical or transcatheter aortic valve replacement (AVR). However, only a few reports have described HALT in sutureless bioprosthesis, which has emerged as a promising tool with excellent hemodynamics and enhanced implantability. We herein report a 75-year-old woman who underwent quintuple coronary artery bypass grafting and sutureless AVR with a Perceval S bioprosthesis (LivaNova PLC, London, UK). Despite an uneventful perioperative course, her recovery was slow with persistent pleural effusion. Echocardiography revealed an increased transvalvular pressure gradient, and HALT was confirmed by computed tomography. The patient received aggressive anticoagulation therapy with resolution of the HALT and made an uneventful recovery. Current guidelines provide no specific recommendations for peri-procedural antithrombotic therapy for sutureless AVR. However, HALT is not rare after sutureless AVR and can lead to significant clinical consequences. In this case, aggressive anticoagulation therapy with systemic heparinization was effective as HALT treatment following early post-sutureless AVR. Further investigation is required to determine the optimal antithrombotic strategy for sutureless AVR.
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Dalén M, Sartipy U, Cederlund K, et al. Hypo-attenuated leaflet thickening and reduced leaflet motion in sutureless bioprosthetic aortic valves. J Am Heart Assoc. 2017. https://doi.org/10.1161/JAHA.116.005251.
Blanke P, Leipsic JA, Popma JJ, et al. Bioprosthetic aortic valve leaflet thickening in the Evolut low risk sub-study. J Am Coll Cardiol. 2020;75:2430–42.
Chakravarty T, Sondergaard L, Friedman J, et al. Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational study. Lancet. 2017;389:2383–92.
Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC Guideline for the Management of Patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol. 2017;70:252–89.
Votsch A, Weihs W, Asslaber M, Dapunt O. Perceval sutureless valve dysfunction caused by valvular thrombosis. Ann Thorac Surg. 2016;102:e309–e311311.
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Uemura, H., Ryomoto, M., Sekiya, N. et al. Hypo-attenuated leaflet thickening and reduced leaflet motion after the implantation of the Perceval S sutureless bioprosthesis. J Artif Organs 24, 293–295 (2021). https://doi.org/10.1007/s10047-020-01213-9
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DOI: https://doi.org/10.1007/s10047-020-01213-9