New data presented Aug. 28 during ESC Congress 2016 in Rome offer a closer look at the incidence, potential predictors, and clinical implications of transcatheter heart valve (THV) thrombosis following transcatheter aortic valve replacement (TAVR).

The study, simultaneously published in the Journal of the American College of Cardiology, looked at 460 patients undergoing TAVR with the Edwards Sapien XT or Sapien 3 valves at Aarhus University Hospital in Denmark between January 2011 and January 2016. Of these patients, 405 (88 percent) underwent contrast-enhanced multidetector computed tomography (MDCT) in addition to transthoracic and transesophageal echocardiography one to three months after TAVR. The MDCT scans were evaluated for hypo-attenuated leaflet thickening indicating THV thrombosis.

Overall results found THV thrombosis in 7 percent of patients (28 of 405). While there was no significant different in THV thrombosis risk between patients receiving the Edwards Sapien XT and the Sapien 3 valves, study authors did note a difference in risk between patients taking warfarin (1.8 percent) and those not taking warfarin (10.7 percent). A larger THV was also associated with an increased THV thrombosis risk (p=0.03). In multivariable analysis, the use of a 29 mm THV and no post-TAVR warfarin treatment, independently predicted THV thrombosis. Treatment with warfarin effectively reverted THV thrombosis and normalized THV function in 85 percent of patients.

“Although often subclinical, THV thrombosis may have important clinical implications,” the study authors said. “Future studies are warranted to assess whether tailored post-TAVR antithrombotic therapy can reduce the incidence of THV thrombosis.”

Keywords: ESC Congress, Aortic Valve Stenosis, Causality, Heart Valves, Incidence, Thrombosis, Angiography

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