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Goleski PJ, Reisman M, Don CW. Reversible thrombotic aortic valve restenosis after valve-in-valve transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2018; 91:165-168. [PMID: 27198960 DOI: 10.1002/ccd.26522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 02/27/2016] [Indexed: 12/21/2022]
Abstract
Thrombotic aortic valve restenosis following transcatheter aortic valve replacement (TAVR) has not been extensively reported and the rates of TAVR valve thrombosis are not known. We present three cases of valve-in-valve (VIV) restenosis following TAVR with the balloon expandable transcatheter heart valves, presumably due to valve thrombosis that improved with anticoagulation. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Patrick J Goleski
- University of Washington, Division of Cardiology, Box 356422, Seattle, WA 98195-6422
| | - Mark Reisman
- University of Washington, Division of Cardiology, Box 356422, Seattle, WA 98195-6422
| | - Creighton W Don
- University of Washington, Division of Cardiology, Box 356422, Seattle, WA 98195-6422
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Nijenhuis VJ, Bennaghmouch N, Kuijk JPV, Capodanno D, ten Berg JM. Antithrombotic treatment in patients undergoing transcatheter aortic valve implantation (TAVI). Thromb Haemost 2017; 113:674-85. [DOI: 10.1160/th14-10-0821] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 11/27/2014] [Indexed: 12/31/2022]
Abstract
SummaryTranscatheter aortic valve implantation (TAVI) is an established treatment option for symptomatic patients with severe aortic valvular disease who are not suitable for conventional surgical aortic valve replacement. Despite improving experience and techniques, ischaemic and bleeding complications after TAVI remain prevalent and impair survival in this generally old and comorbid-rich population. Due to changing aetiology of complications over time, antiplatelet and anticoagulant therapy after TAVI should be carefully balanced. Empirically, a dual antiplatelet strategy is generally used after TAVI for patients without an indication for oral anticoagulation (OAC; e. g. atrial fibrillation, mechanical mitral valve prosthesis), including aspirin and a thienopyridine. For patients on OAC, a combination of OAC and aspirin or thienopyridine is generally used. This review shows that current registries are unfit to directly compare antithrombotic regimens. Small exploring studies suggest that additional clopidogrel after TAVI only affects bleeding and not ischemic complications. However, these studies are lack in quality in terms of Cochrane criteria. Currently, three randomised controlled trials are recruiting to gather more knowledge about the effects of clopidogrel after TAVI.
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Gomes B, Katus HA, Bekeredjian R. Repositionable self-expanding aortic bioprosthesis. Expert Rev Med Devices 2017; 14:565-576. [PMID: 28571486 DOI: 10.1080/17434440.2017.1338136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Transcatheter aortic valve implantation/replacement (TAVI or TAVR) has been established as a first line therapy in patients with symptomatic severe aortic stenosis (AS) at high or prohibitive surgical risk and as an alternative in elderly patients with intermediate surgical risk. Since its first-in-human procedure in 2002, the past 15-years have shown rapid developments in TAVI technology with the introduction and further improvement of new transcatheter heart valves (THV). Areas covered: There are currently several THV systems available, based on balloon-expandable, self-expandable or other technologies. Some of these are repositionable and retrievable even after partial or full deployment, potentially reducing the risk of malpositioning. The aim of this review is to describe such repositionable self-expandable THV systems. Expert commentary: Repositionability potentially represents a crucial step towards higher safety and efficacy of TAVI. It is unclear if full self-expandability or a combination of self and mechanical expansion will be more advantageous.
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Affiliation(s)
- Bruna Gomes
- a Department of Internal Medicine III , University of Heidelberg , Heidelberg , Germany
| | - Hugo A Katus
- a Department of Internal Medicine III , University of Heidelberg , Heidelberg , Germany
| | - Raffi Bekeredjian
- a Department of Internal Medicine III , University of Heidelberg , Heidelberg , Germany
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Vötsch A, Weihs W, Asslaber M, Dapunt O. Perceval Sutureless Valve Dysfunction Caused by Valvular Thrombosis. Ann Thorac Surg 2016; 102:e309-11. [DOI: 10.1016/j.athoracsur.2016.03.108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 03/03/2016] [Accepted: 03/31/2016] [Indexed: 10/21/2022]
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Gonska B, Seeger J, Rodewald C, Scharnbeck D, Rottbauer W, Wöhrle J. Transfemoral valve-in-valve implantation for degenerated bioprosthetic aortic valves using the new balloon-expandable Edwards Sapien 3 valve. Catheter Cardiovasc Interv 2016; 88:636-643. [DOI: 10.1002/ccd.26565] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 03/28/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Birgid Gonska
- Department Of Internal Medicine II; University of Ulm; Ulm Germany
| | - Julia Seeger
- Department Of Internal Medicine II; University of Ulm; Ulm Germany
| | | | | | | | - Jochen Wöhrle
- Department Of Internal Medicine II; University of Ulm; Ulm Germany
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Toggweiler S, Schmidt K, Paul M, Cuculi F, Kobza R, Jamshidi P. Valve thrombosis 3 years after transcatheter aortic valve implantation. Int J Cardiol 2016; 207:122-4. [DOI: 10.1016/j.ijcard.2016.01.080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 01/02/2016] [Indexed: 11/16/2022]
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Thrombus formation following transcatheter aortic valve replacement. JACC Cardiovasc Interv 2016; 8:728-39. [PMID: 25946447 DOI: 10.1016/j.jcin.2015.03.005] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 02/13/2015] [Accepted: 03/03/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVES This paper reviews the published data and reports 3 cases of thrombosis involving CoreValve (Medtronic, Minneapolis, Minnesota) and 1 involving Edward Sapien (Edwards Lifesciences, Irvine, California) devices. Three of these cases had pathological findings at autopsy. BACKGROUND Only a limited number of cases of valve dysfunction with rapid increase of transvalvular aortic gradients or aortic insufficiency post-transcatheter aortic valve replacement (TAVR) have been described. This nonstructural valvular dysfunction has been presumed to be because of early pannus formation or thrombosis. METHODS Through reviews of the published reports and 4 clinical cases, pathological and clinical findings of early valve thrombosis are examined to elucidate methods for recognition and identifying potential causes and treatments. RESULTS This paper presents 4 cases, 2 of which had increasing gradients post-TAVR. All 3 pathology cases showed presence of a valve thrombosis in at least 2 TAV leaflets on autopsy, but were not visualized by transthoracic echocardiogram or transesophageal echocardiogram. One case was medically treated with oral anti coagulation with normalization of gradients. The consequence of valve thrombosis in all 3 pathology patients either directly or indirectly played a role in their early demise. At least 18 case reports of early valve thrombosis have been published. In 12 of these cases, the early treatment with anticoagulation therapy resolved the thrombus formation and normalized aortic pressures gradients successfully. CONCLUSIONS These 4 cases elucidate the occurrence of valve thrombosis post-TAVR. Consideration should be given to treatment with dual antiplatelet therapy and oral anticoagulation in patients post-TAVR with increasing mean pressure gradients and maximum aortic valve velocity. Further research should be conducted to create guidelines for antithrombotic therapy following TAVR procedure.
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Hamm CW, Arsalan M, Mack MJ. The future of transcatheter aortic valve implantation. Eur Heart J 2015; 37:803-10. [PMID: 26578195 DOI: 10.1093/eurheartj/ehv574] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/05/2015] [Indexed: 11/13/2022] Open
Abstract
Since the introduction of transcatheter aortic valve implantation (TAVI) into clinical practice, the treatment of aortic stenosis has changed dramatically. In the past, medical therapy with or without balloon aortic valvuloplasty was the only option for inoperable patients. More recently, TAVI has become the treatment of choice for these patients and the preferred alternative for high-risk operable patients. Surgical aortic valve replacement (SAVR) currently remains the gold standard for patients at low or intermediate operative risk. As randomized trials have demonstrated comparable results between TAVI and SAVR in the high-risk population, there is now a clear trend towards performing TAVI even in intermediate-risk patients while awaiting the results of randomized trials in that population. Nevertheless, there are still questions regarding TAVI involving paravalvular leak (PVL), stroke, pacemaker requirements, and durability that remain to be more definitively answered before TAVI can routinely be performed in a broader, lower risk population. Improvements in patient selection, imaging, and second and third generation devices have decreased the incidence of PVLs and vascular complications that followed the earliest TAVI procedures, but the rates of perioperative stroke and permanent pacemaker implantation must still be addressed. Furthermore, the long-term durability of TAVI devices and a role for post-procedure antithrombotic management remain unanswered. Until these questions are more clearly answered, it is the Heart Team's task to determine the optimal treatment for each patient based on risk scores, frailty metrics, comorbidities, patient preference, and potential for improvement in quality of life.
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Affiliation(s)
- Christian W Hamm
- Department of Medical Clinic I, University of Giessen, Klinikstr. 33, Gießen 35392, Germany Department Cardiac Surgery, Kerckhoff Heart Center, Benekestrasse 2-8, Bad Nauheim 61231, Germany
| | - Mani Arsalan
- Department Cardiac Surgery, Kerckhoff Heart Center, Benekestrasse 2-8, Bad Nauheim 61231, Germany The Heart Hospital Baylor Plano, 1100 Allied Drive, Plano, TX 75093, USA
| | - Michael J Mack
- Cardiovascular Surgery, Baylor Health Care System, Dallas, TX, USA
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Poels TT, Veenstra L, van Ommen V, Kietselaer BL, Das M, Maessen JG, Kats S. Severely Thrombosed Transcatheter Aortic Valve 9 Months After Implantation. Ann Thorac Surg 2015; 100:1441-4. [DOI: 10.1016/j.athoracsur.2014.12.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 11/27/2014] [Accepted: 12/05/2014] [Indexed: 10/23/2022]
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Córdoba-Soriano JG, Puri R, Amat-Santos I, Ribeiro HB, Abdul-Jawad Altisent O, del Trigo M, Paradis JM, Dumont E, Urena M, Rodés-Cabau J. Revisión sistemática de la trombosis protésica tras implante percutáneo de válvula aórtica. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Córdoba-Soriano JG, Puri R, Amat-Santos I, Ribeiro HB, Abdul-Jawad Altisent O, del Trigo M, Paradis JM, Dumont E, Urena M, Rodés-Cabau J. Valve thrombosis following transcatheter aortic valve implantation: a systematic review. ACTA ACUST UNITED AC 2015; 68:198-204. [PMID: 25667117 DOI: 10.1016/j.rec.2014.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 10/10/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES Despite the rapid global uptake of transcatheter aortic valve implantation, valve trombosis has yet to be systematically evaluated in this field. The aim of this study was to determine the clinical characteristics, diagnostic criteria, and treatment outcomes of patients diagnosed with valve thrombosis following transcatheter aortic valve implantation through a systematic review of published data. METHODS Literature published between 2002 and 2012 on valve thrombosis as a complication of transcatheter aortic valve implantation was identified through a systematic electronic search. RESULTS A total of 11 publications were identified, describing 16 patients (mean age, 80 [5] years, 65% men). All but 1 patient (94%) received a balloon-expandable valve. All patients received dual antiplatelet therapy immediately following the procedure and continued to take either mono- or dual antiplatelet therapy at the time of valve thrombosis diagnosis. Valve thrombosis was diagnosed at a median of 6 months post-procedure, with progressive dyspnea being the most common symptom. A significant increase in transvalvular gradient (from 10 [4] to 40 [12] mmHg) was the most common echocardiographic feature, in addition to leaflet thickening. Thrombus was not directly visualized with echocardiography. Three patients underwent valve explantation, and the remaining received warfarin, which effectively restored the mean transvalvular gradient to baseline within 2 months. Systemic embolism was not a feature of valve thrombosis post-transcatheter aortic valve implantation. CONCLUSIONS Although a rare, yet likely under-reported complication of post-transcatheter aortic valve implantation, progressive dyspnea coupled with an increasing transvalvular gradient on echocardiography within the months following the intervention likely signifies valve thrombosis. While direct thrombus visualization appears difficult, prompt initiation of oral anticoagulation therapy effectively restores baseline valve function.
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Affiliation(s)
| | - Rishi Puri
- Quebec Heart & Lung Institute, Quebec City, QC, Canada
| | | | | | | | | | | | - Eric Dumont
- Quebec Heart & Lung Institute, Quebec City, QC, Canada
| | - Marina Urena
- Quebec Heart & Lung Institute, Quebec City, QC, Canada
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Whisenant B, Jones K, Miller D, Horton S, Miner E. Thrombosis following mitral and tricuspid valve-in-valve replacement. J Thorac Cardiovasc Surg 2014; 149:e26-9. [PMID: 25475258 DOI: 10.1016/j.jtcvs.2014.10.075] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 10/03/2014] [Accepted: 10/10/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Brian Whisenant
- Intermountain Heart Institute and Department of Pathology, Salt Lake City, Utah.
| | - Kent Jones
- Intermountain Heart Institute and Department of Pathology, Salt Lake City, Utah
| | - Dylan Miller
- Intermountain Medical Center, Salt Lake City, Utah
| | - Steven Horton
- Intermountain Heart Institute and Department of Pathology, Salt Lake City, Utah
| | - Edward Miner
- Intermountain Heart Institute and Department of Pathology, Salt Lake City, Utah
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Mylotte D, Andalib A, Theriault-Lauzier P, Dorfmeister M, Girgis M, Alharbi W, Chetrit M, Galatas C, Mamane S, Sebag I, Buithieu J, Bilodeau L, de Varennes B, Lachapelle K, Lange R, Martucci G, Virmani R, Piazza N. Transcatheter heart valve failure: a systematic review. Eur Heart J 2014; 36:1306-27. [DOI: 10.1093/eurheartj/ehu388] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 08/28/2014] [Indexed: 11/14/2022] Open
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Iung B, Rodes-Cabau J. The optimal management of anti-thrombotic therapy after valve replacement: certainties and uncertainties. Eur Heart J 2014; 35:2942-9. [DOI: 10.1093/eurheartj/ehu365] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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