Article Impact Level: HIGH Data Quality: STRONG Summary of JACC: Cardiovascular Interventions, 16(24), 2967–2981. https://doi.org/10.1016/j.jcin.2023.10.024 Dr. Yeonwoo Choi et al.
Points
- Subclinical aortic valve complex thrombus is standard post-transcatheter aortic valve replacement (TAVR), with 43.1% of patients exhibiting thrombus at any aortic valve complex.
- Leaflet thrombus was observed in 14.2% of patients, while perivalvular thrombus was present in 37.0% at six months post-TAVR.
- Small maximum stent diameter at the valve level and low body surface area were independent predictors of aortic valve complex and perivalvular thrombus, while decreased renal function was an independent predictor of leaflet thrombus.
- Valvular or perivalvular thrombus did not correlate with new cerebral thromboembolism, neurologic or neurocognitive dysfunction, or adverse clinical outcomes.
- The study’s findings emphasize the need for continued research and clinical vigilance in managing patients undergoing TAVR procedures, providing valuable insights into the frequency, predictors, and clinical implications of subclinical aortic valve complex thrombus.
Summary
The research investigated the frequency, predictors, and clinical implications of subclinical aortic valve complex (valvular and perivalvular) thrombus following transcatheter aortic valve replacement (TAVR). The study, conducted within the ADAPT-TAVR trial, utilized 4-dimensional computed tomography to assess the presence of valvular and perivalvular thrombus at six months post-TAVR. Among the 211 patients evaluated, 43.1% exhibited thrombus at any aortic valve complex, with 14.2% demonstrating leaflet thrombus and 37.0% displaying perivalvular thrombus. Independent predictors of aortic valve complex and perivalvular thrombus included a small maximum stent diameter at the valve level and low body surface area, while decreased renal function emerged as an independent predictor of leaflet thrombus. Notably, valvular or perivalvular thrombus did not correlate with new cerebral thromboembolism, neurologic or neurocognitive dysfunction, or adverse clinical outcomes.
The findings underscore the common occurrence of subclinical aortic valve complex thrombus in patients following successful TAVR, highlighting the significance of these imaging phenomena in the post-procedural context. Despite the high frequency of thrombus, the study revealed that valvular and perivalvular thrombus were not associated with detrimental clinical outcomes or cerebral thromboembolism. Furthermore, identifying independent predictors for these thrombotic phenomena provides valuable insights into the risk factors associated with post-TAVR thrombus formation. The results contribute to a better understanding of the clinical implications of subclinical aortic valve complex thrombus, offering essential considerations for managing and following TAVR patients.
In summary, the study’s comprehensive evaluation of subclinical aortic valve complex thrombus post-TAVR provides valuable insights into these phenomena’ frequency, predictors, and clinical implications. The findings contribute to the existing knowledge base on TAVR-related thrombus formation, emphasizing the need for continued research and clinical vigilance in managing patients undergoing TAVR procedures.
Link to the article: https://www.sciencedirect.com/science/article/abs/pii/S1936879823013857
References Choi, Y., Ahn, J.-M., Kang, D.-Y., Kim, H. J., Kim, H., Lee, J., Kim, M., Park, J., Kim, K. W., Koo, H. J., Yang, D. H., Jung, S. C., Kim, B., Anthony Wong, Y. T., Simon Lam, C. C., Yin, W.-H., Wei, J., Lee, Y.-T., Kao, H.-L., … Park, D.-W. (2023). Frequency, Predictors, and Clinical Impact of Valvular and Perivalvular Thrombus After Transcatheter Aortic Valve Replacement. JACC: Cardiovascular Interventions, 16(24), 2967–2981. https://doi.org/10.1016/j.jcin.2023.10.024
