Subclinical leaflet thrombosis occurs in 10-20% of patients following TAVR and 5-15% following biological SAVR, and is associated with a mild increase in thrombo-embolic risk but not mortality.
Subclinical leaflet thrombosis occurs in 5-20% of patients after bioprosthetic aortic valve replacement, mildly increasing stroke risk and potentially impacting valve durability, though it is generally reversible with vitamin K antagonists.
PURPOSE OF REVIEW: Subclinical leaflet thrombosis (SLT) is often an incidental finding characterized by a thin layer of thrombus involving one, two or three leaflets, with typical appearance on multi-detector computed tomography (MDCT) of hypo-attenuating defect at the aortic side of the leaflet, also called hypo-attenuating leaflet thickening (HALT). SLT may occur following both transcatheter aortic replacement (TAVR) or biological surgical aortic valve replacement (SAVR). The aim of this review is to present an overview of the current state of knowledge on the incidence, diagnosis, clinical impact, and management of SLT following TAVR or SAVR. RECENT FINDINGS: SLT occurs in 10-20% of patients following TAVR and is somewhat more frequent than following SAVR (5-15%). SLT may regress spontaneously without treatment in about 50% of the cases but may also progress to clinically significant valve thrombosis in some cases. Oral anticoagulation with vitamin K antagonist is reasonable if SLT is detected by echocardiography and/or MDCT during follow-up and is generally efficient to reverse SLT. SLT is associated with mild increase in the risk of stroke but has no impact on survival. SLT has been linked with accelerated structural valve deterioration and may thus impact valve durability and long-term outcomes. SUMMARY: SLT is often an incidental finding on echocardiography or MDCT that occurs in 10-20% of patients following TAVR or 5-15% following biological SAVR and is associated with a mild increase in the risk of thrombo-embolic event with no significant impact on mortality but may be associated with reduced valve durability.
Giuliani et al. (Wed,) conducted a review in Subclinical leaflet thrombosis following bioprosthetic aortic valve replacement. Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Incidence of subclinical leaflet thrombosis (SLT). Subclinical leaflet thrombosis occurs in 10-20% of patients following TAVR and 5-15% following biological SAVR, and is associated with a mild increase in thrombo-embolic risk but not mortality.