Key result
Valve thrombosis occurs in ~12% after TMVI, primarily subclinical and predicted by lack of anticoagulation.
Why the study?
The predictors and clinical impact of transcatheter heart valve thrombosis in patients undergoing transcatheter mitral valve implantation were not well defined.
What is the incidence and what are the predictors of transcatheter heart valve thrombosis in high-risk patients undergoing transcatheter mitral valve implantation?
Cohort (n=130)
No
What is the incidence and what are the predictors of transcatheter heart valve thrombosis in high-risk patients undergoing transcatheter mitral valve implantation?
Subclinical THV thrombosis is a common complication after transcatheter mitral valve implantation, highlighting the necessity of routine multimodality imaging and prophylactic anticoagulation for at least three months post-procedure.
THV thrombosis after TMVI is often subclinical and tied to absent anticoagulation; hypothesis-generating for randomized trials on prophylaxis.
AIMS To report the predictors and clinical impact of transcatheter heart valve (THV) thrombosis in patients undergoing transcatheter mitral valve implantation (TMVI). METHODS AND RESULTS We included 130 patients who consecutively underwent TMVI. Transoesophageal echocardiography (TOE) and/or computed tomography (CT) were performed in 91.7% of patients at discharge, in 73.3% at 3 months and in 72% beyond 3 months. THV thrombosis was defined as the presence of at least one thickened leaflet with restricted motion confirmed by TOE or contrast CT and classified as immediate, early, or late according to the timing of diagnosis. THV thrombosis was observed in 16 (12.3%) patients: immediate in 43.7%, early in 37.5% and late in 18.8%. Most of these thromboses were subclinical (93.7%) and non-obstructive (87.5%). No thromboembolic event occurred. After optimization of antithrombotic treatment, THV thromboses resolved in all but one patient. Predictors were shock for immediate (p<0.001), male sex for early (p=0.045) and absence of anticoagulation for both early (p=0.018) and late (p=0.023) THV thromboses. CONCLUSIONS THV thrombosis is frequent after TMVI, occurs mainly within the first 3 months, is mostly subclinical and resolves after optimization of antithrombotic treatment. An anticoagulation therapy for at least 3 months after the procedure is mandatory.
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Kikoïne et al. (2021) conducted a cohort in Severe symptomatic mitral valve disease (n=130). Transcatheter mitral valve implantation (TMVI) was evaluated on Incidence of transcatheter heart valve (THV) thrombosis. Transcatheter heart valve thrombosis occurred in 12.3% of patients following transcatheter mitral valve implantation, was mostly subclinical, and its early occurrence was independently predicted by the absence of anticoagulation.
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