Key result
Transcatheter heart valve thrombosis occurred in 1.14% of patients after TAVI, with higher risk associated with COPD, smaller aortic valve area, higher postprocedural gradient, and lower platelet count.
Why the study?
Data regarding risk factors for transcatheter heart valve thrombosis were conflicting, and no optimal pharmacological treatment strategy had been established.
What are the incidence, risk factors, and optimal treatments for transcatheter heart valve thrombosis (THVT) following TAVI?
Cohort (n=2,307)
Yes
What are the incidence, risk factors, and optimal treatments for transcatheter heart valve thrombosis (THVT) following TAVI?
Answers are grounded in this paper and cite their sources.
Transcatheter heart valve thrombosis is a rare complication of TAVI (1.14% incidence) associated with COPD, smaller aortic valve area, higher postprocedural gradients, and lower platelet counts, which can often be successfully managed with anticoagulation.
BACKGROUND: Conflicting data exist regarding the risk factors for transcatheter heart valve thrombosis (THVT). In addition, no optimal pharmacological strategy to treat THVT has been established so far Aims: The aim of this study was to assess the incidence, risk factors, diagnostic workup, and treatment of THVT in Poland. METHODS: Data were collected retrospectively in themulticenter registry of patients with THVT (ZAK‑POLTAVI) between November 2008 and November 2018. Transcatheter heart valve thrombosis was defined as an increased mean transvalvular gradient accompanied by a decreased effective orifice area or severe aortic regurgitation, reversible after treatment. Baseline characteristics and procedural data were compared between patients with THVT and those without THVT (matched by age, sex, and diabetic status). RESULTS: In a group of 2307 patients undergoing transcatheter aortic valve implantation (TAVI), 26 patients with THVT were identified (incidence, 1.14%). In half of the patients, THVT was diagnosed within 6 months after TAVI. As compared with the control group, patients with THVT more frequently had chronic obstructive pulmonary disease (P = 0.035), a smaller aortic valve area (P = 0.007), a higher mean postprocedural transvalvular gradient (P = 0.037), and a lower platelet count (P = 0.029) at the time of the diagnosis. A total of 24 patients (84.6%) received anticoagulation therapy for THVT, and complete resolution of THVT was noted in 12 individuals (46.1%). We observed thromboembolic complications in 2 patients (7.7%). CONCLUSIONS: Transcatheter heart valve thrombosis is a rare complication of TAVI. However, a higher risk of THVT may be expected in patients with chronic obstructive pulmonary disease, a smaller aortic valve area, a higher mean postprocedural transvalvular gradient, and a lower platelet count. Anticoagulation alone or combined with antiplatelet therapy seems to be the optimal pharmacological treatment in this population.
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Sorysz et al. (2020) conducted a cohort in Transcatheter heart valve thrombosis (THVT) after TAVI (n=2,307). Transcatheter aortic valve implantation (TAVI) was evaluated on Incidence of transcatheter heart valve thrombosis (THVT). Transcatheter heart valve thrombosis occurred in 1.14% of patients after TAVI, with higher risk associated with COPD, smaller aortic valve area, higher postprocedural gradient, and lower platelet count.
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