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Impact of leaflet thrombosis on valve haemodynamic status after transcatheter aortic valve replacement

Authors
Jang, Mi HeeAhn, Jung-MinKang, Do-YoonKim, Kyung WonKoo, Hyun JungYang, Dong HyunJung, Seung ChaiKim, ByungjunWong, Yiu Tung AnthonyLam, Cheung Chi SimonYin, Wei-HsianWei, JengLee, Yung-TsaiKao, Hsien-LiLin, Mao-ShinKo, Tsung-YuKim, Won-JangKang, Se HunKo, EuihongLee, Seung-AhKim, Dae-HeeKim, HoyunChoi, YeonwooLee, JinhoPark, Seung-JungPark, Duk-Woo
Issue Date
Jan-2024
Publisher
BMJ Publishing Group
Keywords
aortic valve stenosis; transcatheter aortic valve replacement
Citation
Heart, v.110, no.2, pp 140 - 147
Pages
8
Indexed
SCIE
SCOPUS
Journal Title
Heart
Volume
110
Number
2
Start Page
140
End Page
147
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/63991
DOI
10.1136/heartjnl-2023-322946
ISSN
1355-6037
1468-201X
Abstract
Objectives The effect of subclinical leaflet thrombosis, characterised by hypoattenuated leaflet thickening (HALT), on the valve haemodynamic function and durability of the bioprosthetic valve, is not yet determined. We determined the impact of HALT on valve haemodynamics after transcatheter aortic valve replacement (TAVR) and the predictors of haemodynamic structural valve deterioration (SVD). Methods The Anticoagulation vs Dual Antiplatelet Therapy for Prevention of Leaflet Thrombosis and Cerebral Embolization after Transcatheter Aortic Valve Replacement(ADAPT-TAVR) trial is a multicenter, randomised trial that compared edoxaban and dual antiplatelet therapy in patients who had undergone successful TAVR. The presence of HALT was evaluated by four-dimensional CT at 6 months and serial echocardiography performed at baseline, immediately post-TAVR and after 6 months. SVD was defined as at least one of the following: (1) mean transprosthetic gradient >= 20 mm Hg, (2) change in the mean gradient >= 10 mm Hg from baseline, or (3) new or increase in intraprosthetic aortic regurgitation of at least >= 1 grade, resulting in moderate or greater regurgitation. Results At 6 months, HALT was found in 30 of 211 (14.2%) patients. The presence of HALT did not significantly affect aortic valve mean gradients (with vs without HALT; 14.0 +/- 4.8 mm Hg vs 13.7 +/- 5.5 mm Hg; p=0.74) at 6 months. SVD was reported in 30 of 206 patients (14.6%) at 6-month follow-up echocardiography. Older age (OR: 1.138; 95% CI: 1.019 to 1.293; p=0.033), use of aortic valve size <= 23 mm (OR: 6.254; 95% CI: 2.230 to 20.569; p=0.001) and mean post-TAVR pressure gradient (OR: 1.233; 95% CI: 1.123 to 1.371; p<0.001) were independent predictors of haemodynamic SVD; however, the presence of HALT was not identified as a predictor of SVD. Conclusions In patients who had undergone successful TAVR, aortic valve haemodynamic status was not influenced by the presence of HALT. Although HALT was not a predictor of haemodynamic SVD at 6 months, it warrants further longer-term follow-up to evaluate the effect on long-term valve durability.
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Anam Hospital (Department of Radiology, Anam Hospital)
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