Skirted prosthetic valves are associated with increased risk of subclinical leaflet thrombosis following transcatheter aortic valve replacement: a multicenter study

Abstract Purpose Subclinical leaflet thrombosis (SLT) is associated with an increased risk of thromboembolic events, valve dysfunction, and mortality in patients undergoing transcatheter aortic valve replacement (TAVR). However, data on the incidence and risk factors of SLT in patients undergoing TAVR using self-expanding valves (SEV) remains limited. This study aims to investigate the incidence and risk factors of SLT in patients undergoing TAVR using SEV. Methods This study included patients who underwent TAVR using SEV and received a postoperative 4D-computed tomography scan within six months at Beijing Anzhen Hospital and Fuwai Hospital. SLT was defined as the presence of hypo-attenuated leaflet thickening (HALT) with or without restricted leaflet motion (RLM), characterized by increased leaflet thickness affecting one or more leaflets. Univariate and multivariable logistic regression analyses were conducted to explore the relationship between variables and the occurrence of SLT. Results A total of 311 patients (mean age 72.02 ± 8.23 years, 52.4% males) were included in the analysis. HALT was detected in 91 patients (29.3%), while RLM was observed in 45 patients (14.5%). Most HALT (81.3%) and RLM (73.4%) cases were graded as grades 1 to 2. Multivariable logistic regression analysis revealed that using skirted prosthetic valves was significantly associated with SLT (adjusted odds ratio: 3.336; 95% confidence interval: 1.491–7.736; p = 0.004). Conclusions Over one-quarter of patients undergoing TAVR using SEV developed SLT within six months. Using skirted prosthetic valves was an independent predictor for SLT in patients undergoing TAVR using SEV.The incidence and risk factor of SLT Severity and distribution of SLT