Key result
HALT after ViV TAVI linked to ~131% higher 3-year risk of major events.
Why the study?
Subclinical leaflet thrombosis (HALT) remains a major concern after ViV TAVI due to its potential impact on valve function and clinical outcomes, and its predictors are not fully defined.
Does the presence of hypoattenuated leaflet thickening (HALT) increase the risk of a composite of all-cause mortality, heart failure hospitalization, or stroke in patients undergoing valve-in-valve TAVI?
Cohort (n=117)
No
Does the presence of hypoattenuated leaflet thickening (HALT) increase the risk of a composite of all-cause mortality, heart failure hospitalization, or stroke in patients undergoing valve-in-valve TAVI?
Odds Ratio: 2.31 (95% CI 1.04–5.15)
p-value: p=0.04
Subclinical leaflet thrombosis (HALT) is frequently observed after valve-in-valve TAVI and is associated with an increased risk of adverse clinical outcomes at 3 years.
HALT may signal higher risk after ViV TAVI; hypothesis-generating and should not yet alter practice or screening.
BACKGROUND: Subclinical leaflet thrombosis, as indicated by hypoattenuated leaflet thickening (HALT) on computed tomography (CT) imaging, remains a major concern owing to its potential impact on valve function and patient outcomes. AIMS: We aimed to evaluate the association between HALT and clinical outcomes in patients undergoing valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) with balloon-expandable valves and to identify predictors of leaflet thrombosis. METHODS: Consecutive patients who underwent ViV TAVI with balloon-expandable valves at the Cedars-Sinai Medical Center were retrospectively analysed. We analysed both pre- and postprocedural CT scans to identify predictors of HALT at 1 month after ViV TAVI and the association of HALT with clinical outcomes. The primary outcome was a composite of all-cause mortality, hospitalisation for heart failure (HF), or stroke at 3 years. RESULTS: Among the 117 patients analysed, HALT was detected in 37 (31.6%). In the multivariable analysis, anticoagulation therapy (odds ratio [OR] 0.28, 95% confidence interval [CI]: 0.08-0.92; p=0.037) and greater transcatheter heart valve (THV) expansion at the minimum area level (OR 0.95, 95% CI: 0.91-0.99; p=0.026) were significant predictors of reduced HALT following ViV TAVI. While there was no significant difference in all-cause mortality between patients with and without HALT (OR 1.13, 95% CI: 0.42-3.02; p=0.8), those with HALT had a significantly higher incidence of the composite primary outcome (OR 2.31, 95% CI: 1.04-5.15; p=0.04). CONCLUSIONS: HALT was frequently observed in patients who underwent ViV TAVI. Additionally, the presence of HALT correlated with a higher incidence of composite outcomes, including all-cause mortality, hospitalisation for HF, and stroke. Assessment of TRanscathetEr and Surgical Aortic BiOprosthetic VaLVe Dysfunction and Its TrEatment with Anticoagulation (RESOLVE; ClinicalTrials.gov: NCT02318342).
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Nagasaka et al. (2025) conducted a cohort in Valve-in-valve transcatheter aortic valve implantation (n=117). Hypoattenuated leaflet thickening (HALT) vs. No HALT was evaluated on Composite of all-cause mortality, hospitalisation for heart failure (HF), or stroke at 3 years (OR 2.31, 95% CI 1.04-5.15, p=0.04). Hypoattenuated leaflet thickening after valve-in-valve TAVI was associated with a higher 3-year incidence of mortality, heart failure hospitalization, or stroke (OR 2.31; 95% CI 1.04-5.15; p=0.04).
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