Untreated early leaflet thrombosis after TAVR did not significantly affect the 2-year cumulative event rates of death, stroke, or rehospitalization for heart failure (10.7% vs 16.9%; P=0.63).
Cohort (n=485)
Yes
Does untreated early leaflet thrombosis increase the risk of death, stroke, or heart failure rehospitalization in patients post-TAVR?
Untreated early subclinical leaflet thrombosis after TAVR does not significantly increase the 2-year risk of death, stroke, or heart failure rehospitalization.
Absolute Event Rate: 10.7% vs 16.9%
p-value: p=0.63
BACKGROUND: The occurrence and clinical impact of untreated subclinical leaflet thrombosis beyond 1 year after transcatheter aortic valve replacement still remain unclear. METHODS AND RESULTS: In a multicenter transcatheter aortic valve replacement registry, we analyzed data from 485 patients who underwent 4-dimensional multidetector computed tomography posttranscatheter aortic valve replacement performed to survey hypoattenuated leaflet thickening with reduced leaflet motion compatible with thrombus at a median of 3 days, 6 months, 1 year, 2 years, and 3 years. Incidence, predictors, and clinical outcomes of early (median 3 days) and late (>30 days) leaflet thrombosis were assessed. Additional anticoagulation was not administered because of subclinical findings at the time of computed tomography in all patients. Early leaflet thrombosis occurred in 45 (9.3%) of 485 patients. Mean pressure gradient at discharge was higher in patients with early leaflet thrombosis than in those without. Independent predictors of early leaflet thrombosis in balloon-expandable prostheses were low-flow, low-gradient aortic stenosis, severe prosthesis-patient mismatch, and 29-mm prostheses. No predictors could be identified for self-expanding prosthesis. Cumulative event rates of death, stroke, or rehospitalization for heart failure over 2 years were 10.7% and 16.9% in patients with and without early leaflet thrombosis, respectively ( P=0.63). Late leaflet thrombosis occurred late up to 3 years, and male sex and paravalvular leak less than mild were independent predictors. CONCLUSIONS: Untreated early leaflet thrombosis did not affect the cumulative event rates of death, stroke, and rehospitalization for heart failure. Late leaflet thrombosis was newly detected during 3-year follow-up. Visual Overview: A visual overview is available for this article.
Yanagisawa et al. (Fri,) conducted a cohort in Transcatheter aortic valve replacement (n=485). Early leaflet thrombosis vs. No early leaflet thrombosis was evaluated on Cumulative event rates of death, stroke, or rehospitalization for heart failure over 2 years (p=0.63). Untreated early leaflet thrombosis after TAVR did not significantly affect the 2-year cumulative event rates of death, stroke, or rehospitalization for heart failure (10.7% vs 16.9%; P=0.63).