Intra-annular valves were associated with a higher rate of CT-defined leaflet thrombosis compared to supra-annular valves following TAVR (13.5% vs. 7%, P = 0.02).
Systematic Review (n=1,644)
Do intra-annular valves compared to supra-annular valves increase the prevalence of computed tomography-defined leaflet thrombosis in patients undergoing TAVR?
Intra-annular TAVR prostheses are associated with a significantly higher prevalence of CT-defined leaflet thrombosis compared to supra-annular prostheses.
Absolute Event Rate: 13.5% vs 7%
p-value: p=0.02
INTRODUCTION: Leaflet thrombosis (LT) defined by computed tomography (CT) following transcatheter aortic valve replacement (TAVR) has been shown to increase cerebrovascular events. The neo-sinus plays an important role in the development of LT. Intra-annular valves (IAV) have a larger neo-sinus when compared to supra-annular valves (SAV), and has been associated with larger thrombus burden. The prevalence of LT with IAV and SAV in a larger, diverse cohort is unknown. METHODS: We performed a systematic review to assess the prevalence of LT in IAV versus SAV TAVR prostheses. Inclusion criteria were (1) reported CT-defined LT following TAVR, (2) comparison between LT and non-LT cohort, (3) separate registry/database, and (4) fully published status. A total of 2,013 citations were reviewed and 7 studies were included. RESULTS: Overall, 1,644 patients were included from 7 observational studies and the prevalence of LT following TAVR was 12.8%. The Portico valve system (IAV) had the highest prevalence of LT with 35.2%, followed by Symetis Acurate Neo (SAV) at 15.4% and the Lotus valve system (IAV) at 14.5%. LT occurred more frequently in IAV than SAV (13.5% vs. 7%, P = 0.02). Subanalysis of IAV versus SAV with the exclusion of the Portico valve was performed to ensure results were not influenced by this valve system and revealed IAV still had higher rates of LT (12.1% vs. 7%, P = 0.05). CONCLUSION: In summary, IAV prostheses appear to be associated with higher rates of LT when compared with SAV.
Rashid et al. (2018) conducted a systematic review in Transcatheter aortic valve replacement (n=1,644). Intra-annular valves (IAV) vs. Supra-annular valves (SAV) was evaluated on CT-defined leaflet thrombosis (p=0.02). Intra-annular valves were associated with a higher rate of CT-defined leaflet thrombosis compared to supra-annular valves following TAVR (13.5% vs. 7%, P = 0.02).