Valvular and perivalvular thrombosis following self-expandable aortic valve replacement: analysis of 100 multi-detector computed tomography scans.

Abstract

Aims: Subclinical thrombosis may represent an early stage of prosthesis structural disease. Most of the available evidence on the incidence, location, predictors, and consequences of thrombosis comes from studies that have employed balloon-expandable valves. We aimed to describe the different localisations of valvular and perivalvular thrombosis and analyse prosthesis-host multi-detector computed tomography predictors in the context of self-expandable prosthesis. Additionally, we aimed to assess the impact of valvular and perivalvular thrombosis on prosthesis performance and subsequent clinical outcomes.

Methods and results: This analysis includes 100 consecutive patients with normal renal function who underwent transcatheter aortic valve replacement using Evolut R and received multi-detector computed tomography and transthoracic bi-dimensional echocardiography at the 6 month follow-up. Leaflet thrombosis was detected in 18 (18%) patients; 6 (6%) had at least one leaflet with severe thrombosis. Thrombosis of the anatomic sinus was detected in 24 patients (24%) and was more prevalent in the non-coronary sinus. Subvalvular thrombosis with partial or complete circumferential involvement of the prosthesis inner skirt was diagnosed in 23 patients (23%). Bicuspid valve was the predictor with highest association with hypoattenuated lesions [least absolute shrinkage and selection operator coefficient 0.35, 95%, confidence interval (CI) 0.21-0.68]. There was no difference in terms of haemodynamic structural valve dysfunction, neurological events, and re-hospitalisation between the groups with and without thrombosis (hazard ratio: 0.86, 95% CI: 0.24-3.06, P = 0.82).

Conclusion: This study showed that in a relatively low-risk population, valvular and perivalvular thrombosis were not rare phenomena following transcatheter aortic valve replacement at early follow-up. Bicuspid valve showed the strongest association with post-implant thrombosis.