Transcatheter Aortic Valve Thrombosis
| Autor: | Kaare T. Jensen, Tina Leetmaa, Erik Lerkevang Grove, Jonathon Leipsic, Jesper M. Jensen, Ole N. Mathiassen, Mariann Tang, Kim Terp, Lars Romer Krusell, Christian Juhl Terkelsen, Nicolaj C. Hansson, Hans Erik Bøtker, John G. Webb, Bjarne L. Nørgaard, Kaj Erik Klaaborg, Henning Rud Andersen, Philipp Blanke, Steen Hvitfeldt Poulsen, Evald Høj Christiansen |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Ejection fraction business.industry medicine.medical_treatment Warfarin 030204 cardiovascular system & hematology medicine.disease Thrombosis 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure Valve replacement Relative risk Internal medicine medicine Cardiology Platelet aggregation inhibitor 030212 general & internal medicine Radiology Heart valve Cardiology and Cardiovascular Medicine business medicine.drug Subclinical infection |
| Zdroj: | Journal of the American College of Cardiology. 68:2059-2069 |
| ISSN: | 0735-1097 |
| Popis: | Background There are limited data on the incidence, clinical implications, and predisposing factors of transcatheter heart valve (THV) thrombosis following transcatheter aortic valve replacement (TAVR). Objectives The authors assessed the incidence, potential predictors, and clinical implications of THV thrombosis as determined by contrast-enhanced multidetector computed tomography (MDCT) after TAVR. Methods Among 460 consecutive patients who underwent TAVR with the Edwards Sapien XT or Sapien 3 (Edwards Lifesciences, Irvine, California) THV, 405 (88%) underwent MDCT in addition to transthoracic and transesophageal echocardiography 1 to 3 months post-TAVR. MDCT scans were evaluated for hypoattenuated leaflet thickening that indicated THV thrombosis. Results MDCT verified THV thrombosis in 28 of 405 (7%) patients. A total of 23 patients had subclinical THV thrombosis, whereas 5 (18%) patients experienced clinically overt obstructive THV thrombosis. THV thrombosis risk did not differ among different generations of THVs (8% vs. 6%; p = 0.42). The risk of THV thrombosis in patients who did not receive warfarin was higher compared with patients who received warfarin (10.7% vs. 1.8%; risk ratio [RR]: 6.09; 95% confidence interval [CI]: 1.86 to 19.84). A larger THV was associated with an increased risk of THV thrombosis (p = 0.03). In multivariable analysis, a 29-mm THV (RR: 2.89; 95% CI: 1.44 to 5.80) and no post-TAVR warfarin treatment (RR: 5.46; 95% CI: 1.68 to 17.7) independently predicted THV thrombosis. Treatment with warfarin effectively reverted THV thrombosis and normalized THV function in 85% of patients as documented by follow-up transesophageal echocardiography and MDCT. Conclusions Incidence of THV thrombosis in this large study was 7%. A larger THV size may predispose to THV thrombosis, whereas treatment with warfarin appears to have a protective effect. Although often subclinical, THV thrombosis may have important clinical implications. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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