Reversible Edwards Sapien XT Dysfunction Due to Prosthesis Thrombosis Presenting as Early Structural Deterioration

Study Questions:

What is the long-term durability of transcatheter heart valves (THVs)?


The authors presented a case series of reversible Edwards Sapien XT dysfunction (Edwards Lifesciences Inc., Irvine, CA), which could have been falsely interpreted as early THV failure.


In this report, the authors presented the first series of symptomatic bioprosthetic dysfunction presenting within 1 to 2 years after transfemoral implantation of a Sapien XT valve. The THV dysfunction was rapidly reversible with anticoagulation, which resulted in normalization of transaortic gradients within 2 months, suggesting probable valve thrombosis.


The authors concluded that the optimal antithrombotic therapy after surgical or transcatheter bioprosthesis implantation is still uncertain.


This case series may have important clinical implications, as it identifies a potentially reversible cause of THV dysfunction. In patients presenting with prosthetic valve stenosis within the first few years after the procedure, an attempt of anticoagulation should be performed before considering a second procedure or valve-in-valve implantation, particularly as the response to therapy appears to occur fairly rapidly. It appears that further research is needed on the optimal antithrombotic strategy after transcatheter aortic valve implantation (TAVI).

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention

Keywords: Uncertainty, Heart Valve Prosthesis, Blood Coagulation, Bioprosthesis, Thrombosis, Constriction, Pathologic, Heart Valve Prosthesis Implantation

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