Is oral anticoagulation effective in preventing transcatheter aortic valve implantation failure? A propensity matched analysis of the Italian Transcatheter balloon-Expandable valve Registry study

2020 ◽  
Vol 21 (1) ◽  
pp. 51-57
Author(s):  
Federico Conrotto ◽  
Fabrizio D’Ascenzo ◽  
Matteo Bianco ◽  
Stefano Salizzoni ◽  
Augusto D’Onofrio ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Oral Anticoagulation ◽  
Implantation Failure ◽  
Registry Study ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

scholarly journals Influence of prosthesis-related factors on the occurrence of early leaflet thrombosis after transcatheter aortic valve implantation

2020 ◽  
Vol 21 (10) ◽  
pp. 1082-1089 ◽  
Author(s):  
Philipp Breitbart ◽  
Gregor Pache ◽  
Jan Minners ◽  
Manuel Hein ◽  
Holger Schröfel ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Oral Anticoagulation ◽  
Left Ventricular ◽  
Related Factors ◽  
Transcatheter Aortic Valve ◽  
Implantation Depth ◽  
Aortic Valve Implantation ◽  
Sapien 3 ◽  
Valve Implantation

Abstract Aims Early leaflet thrombosis (LT) is a well-described phenomenon after transcatheter aortic valve implantation (TAVI) with an incidence around 15%. Data about predictors of LT are scarce. The purpose of the study was to investigate the influence of prosthesis-related factors on the occurrence of LT. Materials and results Fusion imaging of pre- and post-procedural computed tomography angiography was performed in 55 TAVI patients with LT and 140 selected patients as control groups (85 patients in an unmatched and 55 in a matched control) to obtain a 3D reconstruction of the transcatheter heart valve (THV) within the native annulus region. All patients received a balloon-expandable Sapien 3 THV. The THV length above and below the native annulus was measured within the fused images to assess the implantation depth. The deployed THV area was quantified on three heights (left ventricular outflow tract end, stent centre, and aortic end) to determine the average expansion of the prosthesis as percent of the nominal area. We also calculated the extent of prosthesis waist in percent of maximum area. After multivariate adjustment, the extent of THV waist [odds ratio (OR) per 10% (confidence interval, CI) 0.636 (0.526–0.769), P < 0.001] as prosthesis-related factor and previous oral anticoagulation [OR (CI) 0.070 (0.020–0.251), P < 0.001] had significant, independent influence on the occurrence of LT. The implantation depth showed no influence on LT manifestation (P = 0.704). Conclusion Besides the absence of previous oral anticoagulation, a less pronounced waist of the implanted THV was a prosthesis-position-related independent predictor of LT after TAVI using the Sapien 3.

Antithrombotic therapy in patients undergoing transcatheter aortic valve implantation

Heart ◽  
2019 ◽  
Vol 105 (10) ◽  
pp. 742-748 ◽  
Author(s):  
Vincent Johan Nijenhuis ◽  
Jorn Brouwer ◽  
Lars Søndergaard ◽  
Jean-Philippe Collet ◽  
Erik Lerkevang Grove ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Aortic Valve ◽  
Aortic Arch ◽  
Transcatheter Aortic Valve Implantation ◽  
Oral Anticoagulation ◽  
Antithrombotic Therapy ◽  
Coronary Syndrome ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

This review provides a comprehensive overview of the available data on antithrombotic therapy after transcatheter aortic valve implantation (TAVI). In the absence of large randomised clinical trials, clinical practice is leaning towards evidence reported in other populations. Due to the greater risk of major bleeding associated with oral anticoagulation using a vitamin-K antagonist (VKA), antiplatelet therapy (APT) may be considered as the first-line treatment of patients undergoing TAVI. Overall, single rather than dual APT is preferred. However, dual APT should be considered in patients with a recent acute coronary syndrome (ie, within 6 months), complex coronary stenting, large aortic arch atheromas or previous non-cardioembolic stroke. Monotherapy with VKA should be considered if concomitant atrial fibrillation or any other indication for long-term oral anticoagulation is present. APT on top of VKA seems only reasonable in patients with recent acute coronary syndrome, extensive or recent coronary stenting or large aortic arch atheromas. A direct-acting oral anticoagulant may be considered if oral anticoagulation is indicated in the absence of contraindications. Initiation of VKA is indicated in clinical valve thrombosis, for example, with high transvalvular gradient, whereas the role of VKA in the case of subclinical leaflet thrombosis is currently uncertain.

NOAC monotherapy in patients with concomitant indications for oral anticoagulation undergoing transcatheter aortic valve implantation

2018 ◽  
Vol 107 (9) ◽  
pp. 799-806 ◽  
Author(s):  
Nicolas A. Geis ◽  
Christina Kiriakou ◽  
Emmanuel Chorianopoulos ◽  
Lorenz Uhlmann ◽  
Hugo A. Katus ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Oral Anticoagulation ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

scholarly journals Resolution of leaflet thrombosis under anticoagulant therapy in patients after transcatheter aortic valve implantation: influence of prosthesis type and size

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Ferstl ◽  
M Arnold ◽  
M Goeller ◽  
F Ammon ◽  
S Smolka ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Anticoagulant Therapy ◽  
Transcatheter Aortic Valve Implantation ◽  
Oral Anticoagulation ◽  
Univariate Analysis ◽  
Multivariable Logistic Regression Analysis ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Introduction Leaflet thrombosis can frequently be identified by computed tomography angiography (CTA) in patients after transcatheter aortic valve implantation (TAVI). Oral anticoagulation is assumed to lead to resolution of thrombosis. We analyzed the resolution of leaflet thrombosis after TAVI by anticoagulant therapy in serial CTA and assessed the influence of prosthesis type. Methods Consecutive TAVI patients who underwent CTA follow-up were screened and individuals with leaflet thrombosis on CTA (defined by the presence of hypo-attenuated leaflet thickening, HALT) in whom oral anticoagulation was initiated and who underwent follow-up CTA were included. The type of anticoagulation was according to physicians' discretion. We assessed the resolution of HALT and compared patients with and without resolution of HALT regarding prosthesis type, prosthesis diameter and type of anticoagulation. Results Out of 395 patients screened for participation, 36 patients (mean age 80±7, 67% men) with leaflet thrombosis underwent follow-up CTA at a medial interval of 3 months (IQR: 3; 5.75 months) after anticoagulation was initiated. 36 patients received either vitamin-K antagonists (n=28, 78%) or Factor-Xa Inhibitors (n=8, 22%). A total of 22 (61%) balloon-expandable and 14 (39%) self-expandable transcatheter aortic valves were implanted. Nominal prosthesis diameter was 23, 25, 26, 27 and 29 mm in 7 (19%), 1 (3%), 10 (28%), 7 (19%) and 11 (31%) patients, respectively. 30 patients (83%) with anticoagulation showed resolution of HALT, whereas persistent HALT was detected in 6 patients (17%), of whom 1 patient with balloon-expandable and 5 patients with self-expandable valve. No difference was seen in duration of anticoagulation between patients with and without resolution of HALT (p=0.984). In univariate analysis, prosthesis type (balloon-expandable vs. self-expandable valves) showed a significant association of self-expandable valves with lack of resolution of leaflet thrombosis (p=0.017). In multivariable logistic regression analysis, this association persisted (p=0.043) and was independent of the type of anticoagulation (p=0.660) and prosthesis diameter (p=0.942). Conclusion Persisting leaflet thrombosis despite anticoagulation is not infrequent and seems to be associated with prosthesis-type rather than small valve diameter or type of anticoagulation. Further research is necessary to identify structural aortic valve determinants for this finding. Funding Acknowledgement Type of funding source: None

scholarly journals Leaflet thrombosis after valve-in-valve transcatheter aortic valve implantation: a case series

2020 ◽  
Vol 4 (4) ◽  
pp. 1-6 ◽  
Author(s):  
Dincer Aktuerk ◽  
Saeed Mirsadraee ◽  
Cesare Quarto ◽  
Simon Davies ◽  
Alison Duncan
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Oral Anticoagulation ◽  
Anticoagulation Therapy ◽  
Case Series ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
Valve In Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) in degenerated surgical aortic valve replacement (SAVR) is an alternative to redo-SAVR. However, reports on leaflet thrombosis following ViV-TAVI are emerging and subclinical thrombosis has gained recent attention. Although the incidence of transcatheter heart valve (THV) thrombosis after TAVI for native aortic valve disease is low, current imaging studies suggest the incidence of subclinical THV thrombosis may be significantly higher. While anticoagulation strategies for THV patients for native aortic stenosis presenting with symptomatic obstructive thrombosis has been described, the optimal management and anticoagulation therapy of patients with THV thrombosis following ViV-TAVI are less evident. Case summary We report a case series of three patients presenting with early and late THV thrombosis after ViV-TAVI. Two patients presented clinically on single antiplatelet therapy and one patient presented with subclinical valve thrombosis whilst taking a non-vitamin K oral anticoagulation agent. Discussion Leaflet thrombosis after ViV-TAVI is an important cause of THV degeneration and may present subclinically. Imaging modalities such as serial transthoracic echocardiograms and multidetector computerized tomography aid diagnosis and guide management. Patient-individualized risk- vs. -benefit prophylactic post-procedural oral anticoagulation may be indicated.

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