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Rashid HN, Rajani R, Leipsic J, Maurovitch-Horvat P, Patterson T, Redwood S, Lee J, Hurrell H, Nicholls SJ, Nasis A, Seneviratne S, Cameron JD, Prendergast B, Gooley RP. Computed tomography imaging for subclinical leaflet thrombosis following surgical and transcatheter aortic valve replacement. J Cardiovasc Comput Tomogr 2023; 17:2-10. [PMID: 36396555 DOI: 10.1016/j.jcct.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/31/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022]
Abstract
Subclinical leaflet thrombosis (LT) may occur following surgical and transcatheter aortic valve replacement. Computed tomography (CT) has become an established imaging modality to diagnose subclinical LT following bioprosthetic aortic valve replacement. Even so, there is a limited (but growing) experience in utilizing CT imaging for this indication. This review emphasizes a systematic approach to acquiring and analysing CT imaging for subclinical LT, highlighting evidence surrounding clinical sequelae of subclinical LT and anti-thrombotic implications following diagnosis.
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Affiliation(s)
- Hashrul N Rashid
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia; Department of Cardiology, Guy's & St. Thomas' Hospital, London, United Kingdom.
| | - Ronak Rajani
- Department of Cardiology, Guy's & St. Thomas' Hospital, London, United Kingdom.
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Pál Maurovitch-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Budapest, Hungary.
| | - Tiffany Patterson
- Department of Cardiology, Guy's & St. Thomas' Hospital, London, United Kingdom; School of Cardiovascular Medicine & Sciences, King's College London, London, United Kingdom.
| | - Simon Redwood
- Department of Cardiology, Guy's & St. Thomas' Hospital, London, United Kingdom; School of Cardiovascular Medicine & Sciences, King's College London, London, United Kingdom.
| | - Jack Lee
- Biomedical Engineering Department, King's College London, London, United Kingdom.
| | - Harriet Hurrell
- Department of Cardiology, Guy's & St. Thomas' Hospital, London, United Kingdom; School of Cardiovascular Medicine & Sciences, King's College London, London, United Kingdom.
| | - Stephen J Nicholls
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
| | - Arthur Nasis
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
| | - Sujith Seneviratne
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
| | - James D Cameron
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
| | - Bernard Prendergast
- Department of Cardiology, Guy's & St. Thomas' Hospital, London, United Kingdom.
| | - Robert P Gooley
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
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Rashid HN, Cameron JD, Gooley RP. Early Bioprosthetic Valve Dysfunction Following TAVR: The Role of CT Imaging in Diagnosing Acute Leaflet Thrombosis. Heart Lung Circ 2022; 31:e120-e122. [PMID: 35513965 DOI: 10.1016/j.hlc.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/20/2022] [Accepted: 03/27/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Hashrul N Rashid
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia.
| | - James D Cameron
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia
| | - Robert P Gooley
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia
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Prosthesis Geometrical Predictors of Leaflet Thrombosis Following Transcatheter Aortic Valve Replacement With Intra-Annular Prostheses. Heart Lung Circ 2022; 31:678-684. [PMID: 35065896 DOI: 10.1016/j.hlc.2021.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/25/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the association between prosthesis geometry with leaflet thrombosis (LT). BACKGROUND Leaflet thrombosis following transcatheter aortic valve replacement (TAVR) is a recognised entity. The association between prosthesis geometry with LT is unclear but maybe a potential modifiable factor in its prevention. METHODS Patients who received an intra-annular TAVR prosthesis and were prospectively planned to undergo post-procedural computed tomography (CT) imaging were included. Leaflet thrombosis was defined as at least 50% restricted leaflet motion on CT. Prosthesis expansion and eccentricity was measured at prosthesis inflow, annulus and outflow levels. Prosthesis misalignment was defined as the average angle deviation between native and prosthesis leaflet commissure, greater than 30°. RESULTS Prevalence of LT was 13.7% in 117 patients. None of the patients with LT were on anticoagulation therapy. Patients with LT had reduced prosthesis annular expansion (89.4±5.2% vs 97.0±4.4%, p<0.01), greater prosthesis misalignment (81.3% vs 48.5%, p=0.02) and deeper implants (6.3±1.7 mm vs 4.3±1.5 mm, p<0.01). Threshold for the presence of LT on ROC analysis was an implant depth of 5.7 mm (AUC [area under curve]=0.81). Independent predictors of LT were annular under-expansion (Odds ratio [OR] 1.4, 95% confidence interval [CI] 1.2-1.7, p=0.03) prosthesis misalignment (OR 6.8, 95%CI 1.1-45.5, p=0.04) and implant depth (OR 1.9, 95%CI 1.1-3.2, p=0.03). Anticoagulation therapy was a protective factor (OR 0.2; 95%CI 0.1-0.4, p<0.01). CONCLUSION Geometrical predictors of LT post intra-annular TAVR were reduced prosthesis expansion at the annular level, lower implant depth and greater prosthesis misalignment. These factors may be important considerations during procedural planning for TAVR.
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Rashid HN, Michail M, Ramnarain J, Nasis A, Nicholls SJ, Cameron JD, Gooley RP. The impact of hypo-attenuated leaflet thickening on haemodynamic valve deterioration following transcatheter aortic valve replacement. J Cardiovasc Comput Tomogr 2021; 16:168-173. [PMID: 34852974 DOI: 10.1016/j.jcct.2021.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/10/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Hypo-attenuated leaflet thickening (HALT) may occur following transcatheter aortic valve replacement (TAVR), however, it remains unclear if HALT is a predictor of haemodynamic valve deterioration (HVD). AIM To determine the impact of HALT on the occurrence of HVD. METHODS We prospectively evaluated 186 patients for the presence of HALT at a median of 6 weeks following TAVR (Interquartile-range [IQR] 4-12 weeks). HALT depth and area were measured. HVD encompassed any of the following: mean gradient ≥20 mmHg with an increase in gradient ≥10 mmHg from baseline, Doppler velocity index reduction ≥0.1 or new moderate-to-severe valvular regurgitation. Routine echocardiograms at discharge, one month and annually, were assessed by echo-cardiologists that were blinded to the HALT status. RESULTS LT prevalence was 17.7% (33/186). HVD was present in 8.6% (16/186) at a median follow-up of 2 years (IQR 1-3); two required valve re-intervention and five required anticoagulation. HALT was the only independent predictor of HVD on multivariate analysis (OR 33.3, 95%CI 7.4-125). Patients with HALT were more likely to develop HVD, require repeat valve intervention and have higher trans-valvular gradients at up to 3-year follow-up. Patients with HALT had a median cumulative thickness of 2.9 mm (IQR 1.9-4.7) and area of 64.2 mm2 (IQR 40.9-91.6). Thresholds for HALT in predicting HVD were a cumulative depth of 2.4 mm (Specificity 94.1%, Sensitivity 75.0%, AUC = 0.87) and cumulative area of 28 mm2 (Specificity 92.2%, Sensitivity 81.3%, AUC = 0.86). CONCLUSION HALT is an independent predictor of HVD, which exhibits specific depth and area thresholds to predict HVD. CT following TAVR may determine patients at risk of HVD.
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Affiliation(s)
- Hashrul N Rashid
- Monash Heart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Australia.
| | - Michael Michail
- Sussex Cardiac Centre, University Hospital Sussex NHS Trust, Brighton, United Kingdom
| | - Jaineel Ramnarain
- Monash Heart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Australia
| | - Arthur Nasis
- Monash Heart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Australia
| | - Stephen J Nicholls
- Monash Heart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Australia
| | - James D Cameron
- Monash Heart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Australia
| | - Robert P Gooley
- Monash Heart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Australia
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Poschner T, Werner P, Kocher A, Laufer G, Musumeci F, Andreas M, Russo M. The JenaValve pericardial transcatheter aortic valve replacement system to treat aortic valve disease. Future Cardiol 2021; 18:101-113. [PMID: 34647465 DOI: 10.2217/fca-2021-0065] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Transcatheter aortic valve replacement is a valuable alternative technique to surgery and the spectrum of therapy continues to evolve. The JenaValve Pericaridal transcatheter aortic valve replacement System allows prosthesis fixation in a native, noncalcified aortic annulus with a unique paper clip-like anchorage mechanism. The low rate of paravalvular leakage and permanent pacemaker implantation emphasizes the further widespread use of the JenaValve - despite the limited data available. In May 2021, a CE mark for the transfemoral implantation in both aortic regurgitation and aortic stenosis was granted. However, no data have been published so far. The ongoing ALIGN trials are expected to provide the pending long-term data.
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Affiliation(s)
- Thomas Poschner
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Paul Werner
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Alfred Kocher
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Guenther Laufer
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Francesco Musumeci
- Department of Cardiac Surgery & Heart Transplantation, San Camillo Forlanini Hospital of Rome, Rome, Italy
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Marco Russo
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria.,Department of Cardiac Surgery & Heart Transplantation, San Camillo Forlanini Hospital of Rome, Rome, Italy
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