MDCT-defined leaflet thrombosis following aortic bioprosthetic valve replacement was associated with an increased risk of cerebrovascular events (OR 3.38; 95% CI 1.78-6.41; p<0.001).
Meta-Analysis (n=1,704)
Does MDCT-defined leaflet thrombosis increase the risk of adverse cerebrovascular events in patients following aortic bioprosthetic valve replacement?
MDCT-defined leaflet thrombosis following bioprosthetic aortic valve replacement is associated with a more than 3-fold increased risk of adverse cerebrovascular events.
Odds Ratio: 3.38 (95% CI 1.78–6.41)
p-value: p=<0.001
AIMS: Leaflet thrombosis (LT) has become increasingly recognised following transcatheter and surgical aortic bioprosthetic valve (ABV) replacement and can be reliably identified by multidetector computed tomography (MDCT). However, it is an ongoing debate whether MDCT-defined LT is associated with adverse cerebrovascular outcomes. We sought to perform a systematic review and meta-analysis in order to assess the incidence and clinical outcomes associated with MDCT-defined leaflet thrombosis following (ABV) replacement. METHODS AND RESULTS: Electronic databases were searched for studies that performed mandatory MDCT imaging following ABV replacement. The primary endpoint was the incidence of cerebrovascular events, defined as a composite of stroke or transient ischaemic attack (TIA). Secondary endpoints included major adverse cerebrovascular and cardiovascular events (MACCE), stroke, TIA, death or myocardial infarction. In total, six studies met the inclusion criteria with 11.6% (198/1,704) of patients having MDCT-defined LT. The prevalence of LT following transcatheter and surgical ABV replacement was 13.2% and 3.6%, respectively. Cerebrovascular events were significantly increased in patients with LT (odds ratio OR 3.38, 95% CI: 1.78-6.41, p<0.001). The risk of MACCE (OR 2.10, 95% CI: 1.21-3.64, p<0.001) and TIA (OR 5.86, 95% CI: 2.05-16.75, p<0.001) was also increased in patients with LT, although there were no differences in the incidence of stroke (OR 2.43, 95% CI: 1.00-5.93, p=0.05), death (OR 0.92, 95% CI: 0.42-2.03, p=0.84) or myocardial infarction (OR 1.72, 95% CI: 0.34-9.78, p=0.54) between groups. CONCLUSIONS: MDCT-defined LT following ABV replacement is associated with a significantly increased risk of adverse cerebrovascular events. Further prospective studies are required to ascertain whether LT can be prevented or treated with pharmacological strategies.
Rashid et al. (2018) conducted a meta-analysis in Aortic bioprosthetic valve replacement (n=1,704). MDCT-defined leaflet thrombosis vs. No leaflet thrombosis was evaluated on Cerebrovascular events (composite of stroke or transient ischaemic attack) (OR 3.38, 95% CI 1.78-6.41, p=<0.001). MDCT-defined leaflet thrombosis following aortic bioprosthetic valve replacement was associated with an increased risk of cerebrovascular events (OR 3.38; 95% CI 1.78-6.41; p<0.001).