Transcatheter Aortic Valve Thrombosis Incidence, Predisposing Factors, and Clinical Implications

被引：284

作者：

Hansson, Nicolaj C. ^{[1
]}

Grove, Erik L. ^{[1
,2
]}

Andersen, Henning R. ^{[1
]}

Leipsic, Jonathon ^{[3
,4
]}

Mathiassen, Ole N. ^{[1
]}

Jensen, Jesper M. ^{[1
]}

Jensen, Kaare T. ^{[1
]}

Blanke, Philipp ^{[3
,4
]}

Leetmaa, Tina ^{[1
]}

Tang, Mariann ^{[5
]}

Krusell, Lars R. ^{[1
]}

Klaaborg, Kaj E. ^{[5
]}

Christiansen, Evald H. ^{[1
]}

Terp, Kim ^{[5
]}

Terkelsen, Christian J. ^{[1
]}

Poulsen, Steen H. ^{[1
]}

Webb, John ^{[3
,4
]}

Botker, Hans Erik ^{[1
,2
]}

Norgaard, Bjarne L. ^{[1
]}

机构：

[1] Aarhus Univ Hosp, Dept Cardiol, Aarhus, Denmark

[2] Aarhus Univ, Fac Hlth, Inst Clin Med, Aarhus, Denmark

[3] Univ British Columbia, St Pauls Hosp, Dept Med Imaging, Vancouver, BC, Canada

[4] Univ British Columbia, St Pauls Hosp, Div Cardiol, Vancouver, BC, Canada

[5] Aarhus Univ Hosp, Dept Cardiothorac Surg, Aarhus, Denmark

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2016年 / 68卷 / 19期

关键词：

aortic stenosis; multidetector computed tomography; platelet aggregation inhibitors; transcatheter aortic valve replacement; warfarin; REPLACEMENT; IMPLANTATION; MULTICENTER; IMPACT;

D O I：

10.1016/j.jacc.2016.08.010

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 multi-variable 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. (C) 2016 by the American College of Cardiology Foundation.

引用

页码：2059 / 2069

页数：11

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