Preliminary analysis of subclinical leaflet thrombosis after percutaneous aortic valve replacement with balloon dilation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Yihang , ZHANG Jingnan , FANG Fang , WAN Junyi , XU Liang ,  PAN Xiangbin ,  ZHANG Gejun

Department of Cardiology, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, P. R. China;

Corresponding author：

PAN Xiangbin, Email: panxiangbin@fuwaihospital.org; ZHANG Gejun, Email: gjzhang212@163.com

Keywords：

Percutaneous aortic valve replacement; balloon-expandable valves; subclinical leaflet thrombosis

DOI：

10.7507/1007-4848.202210057

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To analyze the factors influencing the occurrence of subclinical leaflet thrombosis (SLT) after percutaneous aortic valve replacement using balloon-expandable valve (Sapien3, S3). Methods Retrospective analysis was made on 62 patients with severe aortic stenosis undergoing percutaneous aortic valve replacement using S3 in our center from September 2020 to June 2022. Patients with a history of vascular atherosclerosis or with significant increase or insignificant decrease of aortic valve flow or gradient pressure during follow-up were selected for CT examination. Results A total of 26 patients were finally included, with an average age of 70.31±8.90 years, and the male proportion was higher (n=15, 57.69%). Among them, 5 patients had SLT. Compared with the non-SLT group, patients in the SLT group were older (68.52±8.80 years vs. 77.80±4.66 years, P=0.007). The age factor (≥75 years) and the diameter of the ascending aorta were associated with SLT (both P<0.05). Conclusion The incidence of SLT is higher in the elderly patients. It is speculated that SLT is related to the characteristics of short balloon dilation valves and low blood flow dynamics of valve racks.

Citation： LI Yihang, ZHANG Jingnan, FANG Fang, WAN Junyi, XU Liang, PAN Xiangbin, ZHANG Gejun. Preliminary analysis of subclinical leaflet thrombosis after percutaneous aortic valve replacement with balloon dilation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(3): 410-415. doi: 10.7507/1007-4848.202210057 Copy

1.	Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2016, 374(17): 1609-1620.
2.	Ng ACT, Holmes DR, Mack MJ, et al. Leaflet immobility and thrombosis in transcatheter aortic valve replacement. Eur Heart J, 2020, 41(33): 3184-3197.
3.	Vollema EM, Kong WKF, Katsanos S, et al. Transcatheter aortic valve thrombosis: The relation between hypo-attenuated leaflet thickening, abnormal valve haemodynamics, and stroke. Eur Heart J, 2017, 38(16): 1207-1217.
4.	Vlastra W, Chandrasekhar J, Muñoz-Garcia AJ, et al. Comparison of balloon-expandable vs. self-expandable valves in patients undergoing transfemoral transcatheter aortic valve implantation: From the CENTER-collaboration. Eur Heart J, 2019, 40(5): 456-465.
5.	Abdel-Wahab M, Neumann FJ, Mehilli J, et al. 1-year outcomes after transcatheter aortic valve replacement with balloon-expandable versus self-expandable valves: Results from the CHOICE randomized clinical trial. J Am Coll Cardiol, 2015, 66(7): 791-800.
6.	Deharo P, Bisson A, Herbert J, et al. Impact of Sapien 3 balloon-expandable versus Evolut R self-expandable transcatheter aortic valve implantation in patients with aortic stenosis: Data from a nationwide analysis. Circulation, 2020, 141(4): 260-268.
7.	Brown RA, Khanji MY, Mullen M, et al. Hypoattenuated leaflet thickening associated with symptomatic thrombotic prosthetic valve obstruction: Early complication following transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging, 2020, 21(1): 115.
8.	Yanagisawa R, Tanaka M, Yashima F, et al. Early and late leaflet thrombosis after transcatheter aortic valve replacement. Circ Cardiovasc Interv, 2019, 12(2): e007349.
9.	Makkar RR, Blanke P, Leipsic J, et al. Subclinical leaflet thrombosis in transcatheter and surgical bioprosthetic valves: PARTNER 3 cardiac computed tomography substudy. J Am Coll Cardiol, 2020, 75(24): 3003-3015.
10.	Bogyi M, Schernthaner RE, Loewe C, et al. Subclinical leaflet thrombosis after transcatheter aortic valve replacement: A meta-analysis. JACC Cardiovasc Interv, 2021, 14(24): 2643-2656.
11.	Overtchouk P, Guedeney P, Rouanet S, et al. Long-term mortality and early valve dysfunction according to anticoagulation use: The FRANCE TAVI registry. J Am Coll Cardiol, 2019, 73(1): 13-21.
12.	Ruile P, Minners J, Breitbart P, et al. Medium-term follow-up of early leaflet thrombosis after transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2018, 11(12): 1164-1171.
13.	Cheng SQ, Liu NF, Fang LJ, et al. Factors predicting the occurrence of aortic valve calcification in patients with coronary artery calcification in China. Acta Cardiol, 2022: 1-8.
14.	Midha PA, Raghav V, Sharma R, et al. The fluid mechanics of transcatheter heart valve leaflet thrombosis in the neosinus. Circulation, 2017, 136(17): 1598-1609.
15.	Rodriguez-Gabella T, Voisine P, Puri R, et al. Aortic bioprosthetic valve durability: Incidence, mechanisms, predictors, and management of surgical and transcatheter valve degeneration. J Am Coll Cardiol, 2017, 70(8): 1013-1028.
16.	Blanke P, Leipsic JA, Popma JJ, et al. Bioprosthetic aortic valve leaflet thickening in the evolut low risk sub-study. J Am Coll Cardiol, 2020, 75(19): 2430-2442.
17.	Chau KH, Douglas PS, Pibarot P, et al. Regression of left ventricular mass after transcatheter aortic valve replacement: The PARTNER trials and registries. J Am Coll Cardiol, 2020, 75(19): 2446-2458.
18.	Waksman R, Torguson R, Medranda GA, et al. Transcatheter aortic valve replacement in low-risk patients: 2-year results from the LRT trial. Am Heart J, 2021, 237: 25-33.
19.	Reardon MJ, Feldman TE, Meduri CU, et al. Two-year outcomes after transcatheter aortic valve replacement with mechanical vs self-expanding valves: The REPRISE Ⅲ randomized clinical trial. JAMA Cardiol, 2019, 4(3): 223-229.
20.	Vahidkhah K, Javani S, Abbasi M, et al. Blood stasis on transcatheter valve leaflets and implications for valve-in-valve leaflet thrombosis. Ann Thorac Surg, 2017, 104(3): 751-759.
21.	Pibarot P, Dumesnil JG. Prosthesis-patient mismatch: Definition, clinical impact, and prevention. Heart, 2006, 92(8): 1022-1029.

1. Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2016, 374(17): 1609-1620.
2. Ng ACT, Holmes DR, Mack MJ, et al. Leaflet immobility and thrombosis in transcatheter aortic valve replacement. Eur Heart J, 2020, 41(33): 3184-3197.
3. Vollema EM, Kong WKF, Katsanos S, et al. Transcatheter aortic valve thrombosis: The relation between hypo-attenuated leaflet thickening, abnormal valve haemodynamics, and stroke. Eur Heart J, 2017, 38(16): 1207-1217.
4. Vlastra W, Chandrasekhar J, Muñoz-Garcia AJ, et al. Comparison of balloon-expandable vs. self-expandable valves in patients undergoing transfemoral transcatheter aortic valve implantation: From the CENTER-collaboration. Eur Heart J, 2019, 40(5): 456-465.
5. Abdel-Wahab M, Neumann FJ, Mehilli J, et al. 1-year outcomes after transcatheter aortic valve replacement with balloon-expandable versus self-expandable valves: Results from the CHOICE randomized clinical trial. J Am Coll Cardiol, 2015, 66(7): 791-800.
6. Deharo P, Bisson A, Herbert J, et al. Impact of Sapien 3 balloon-expandable versus Evolut R self-expandable transcatheter aortic valve implantation in patients with aortic stenosis: Data from a nationwide analysis. Circulation, 2020, 141(4): 260-268.
7. Brown RA, Khanji MY, Mullen M, et al. Hypoattenuated leaflet thickening associated with symptomatic thrombotic prosthetic valve obstruction: Early complication following transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging, 2020, 21(1): 115.
8. Yanagisawa R, Tanaka M, Yashima F, et al. Early and late leaflet thrombosis after transcatheter aortic valve replacement. Circ Cardiovasc Interv, 2019, 12(2): e007349.
9. Makkar RR, Blanke P, Leipsic J, et al. Subclinical leaflet thrombosis in transcatheter and surgical bioprosthetic valves: PARTNER 3 cardiac computed tomography substudy. J Am Coll Cardiol, 2020, 75(24): 3003-3015.
10. Bogyi M, Schernthaner RE, Loewe C, et al. Subclinical leaflet thrombosis after transcatheter aortic valve replacement: A meta-analysis. JACC Cardiovasc Interv, 2021, 14(24): 2643-2656.
11. Overtchouk P, Guedeney P, Rouanet S, et al. Long-term mortality and early valve dysfunction according to anticoagulation use: The FRANCE TAVI registry. J Am Coll Cardiol, 2019, 73(1): 13-21.
12. Ruile P, Minners J, Breitbart P, et al. Medium-term follow-up of early leaflet thrombosis after transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2018, 11(12): 1164-1171.
13. Cheng SQ, Liu NF, Fang LJ, et al. Factors predicting the occurrence of aortic valve calcification in patients with coronary artery calcification in China. Acta Cardiol, 2022: 1-8.
14. Midha PA, Raghav V, Sharma R, et al. The fluid mechanics of transcatheter heart valve leaflet thrombosis in the neosinus. Circulation, 2017, 136(17): 1598-1609.
15. Rodriguez-Gabella T, Voisine P, Puri R, et al. Aortic bioprosthetic valve durability: Incidence, mechanisms, predictors, and management of surgical and transcatheter valve degeneration. J Am Coll Cardiol, 2017, 70(8): 1013-1028.
16. Blanke P, Leipsic JA, Popma JJ, et al. Bioprosthetic aortic valve leaflet thickening in the evolut low risk sub-study. J Am Coll Cardiol, 2020, 75(19): 2430-2442.
17. Chau KH, Douglas PS, Pibarot P, et al. Regression of left ventricular mass after transcatheter aortic valve replacement: The PARTNER trials and registries. J Am Coll Cardiol, 2020, 75(19): 2446-2458.
18. Waksman R, Torguson R, Medranda GA, et al. Transcatheter aortic valve replacement in low-risk patients: 2-year results from the LRT trial. Am Heart J, 2021, 237: 25-33.
19. Reardon MJ, Feldman TE, Meduri CU, et al. Two-year outcomes after transcatheter aortic valve replacement with mechanical vs self-expanding valves: The REPRISE Ⅲ randomized clinical trial. JAMA Cardiol, 2019, 4(3): 223-229.
20. Vahidkhah K, Javani S, Abbasi M, et al. Blood stasis on transcatheter valve leaflets and implications for valve-in-valve leaflet thrombosis. Ann Thorac Surg, 2017, 104(3): 751-759.
21. Pibarot P, Dumesnil JG. Prosthesis-patient mismatch: Definition, clinical impact, and prevention. Heart, 2006, 92(8): 1022-1029.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Preliminary analysis of subclinical leaflet thrombosis after percutaneous aortic valve replacement with balloon dilation

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