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Clinical Research in Cardiology

, Volume 108, Issue 9, pp 1017–1024 | Cite as

Haemodynamic prosthetic valve performance in patients with early leaflet thrombosis after transcatheter aortic valve implantation

  • Manuel HeinEmail author
  • Jan Minners
  • Nikolaus Jander
  • Philipp Breitbart
  • Christian Stratz
  • Gregor Pache
  • Franz-Josef Neumann
  • Philipp Ruile
Original Paper

Abstract

Aims

We sought to evaluate haemodynamic prosthetic valve performance in patients with early leaflet thrombosis (LT) after transcatheter aortic valve implantation (TAVI).

Method and Results

In this retrospective observational study, 59 patients with LT underwent clinical and echocardiographic follow-up. During a median follow-up of 383 days 41 patients received antiplatelet therapy (APT-group) and 18 patients oral anticoagulation due to atrial fibrillation (AC-group). The mean pressure gradient (MPG) at baseline did not differ between groups (P = 0.875). During follow-up, MPG increased from 11.0 (9.0; 14.5) to 13.0 mmHg (10.0; 18.0)_ in the APT-group (P = 0.010) but remained unchanged in the AC-group (P = 0.297) resulting in a significantly higher MPG in patients on antiplatelet therapy (P = 0.024). Similarly, change of MPG per year was significantly higher in the APT-group [1.4 (− 0.9; 7.0) vs. − 0.6 (− 2.5; 1.1), P = 0.014]. Seven (17.1%) patients in the APT-group and two(11.1%) patients in the AC-group developed MPGs of at least 20 mmHg (P = 0.558). Three patients (7.3%) in the APT- and none in the AC-group developed symptoms of obstructive thrombosis (P = 0.239). In our adjusted analysis, only lack of anticoagulation was significantly associated with change in gradients during follow-up (P = 0.012).

Conclusions

In patients with LT, antiplatelet-, but not anticoagulant therapy, was associated with significant increases in MPG, which may lead to symptomatic obstructive valve thrombosis.

Keywords

Transcatheter aortic valve implantation (TAVI) Aortic stenosis Leaflet thrombosis Hypo-attenuated leaflet thickening Echocardiography 

Notes

Compliance with ethical standards

Conflict of interest

Dr. Pache: consultant for Edwards Lifesciences Inc. The other authors have no conflicts of interest to declare.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Manuel Hein
    • 1
    Email author
  • Jan Minners
    • 1
  • Nikolaus Jander
    • 1
  • Philipp Breitbart
    • 1
  • Christian Stratz
    • 1
  • Gregor Pache
    • 2
  • Franz-Josef Neumann
    • 1
  • Philipp Ruile
    • 1
  1. 1.Department of Cardiology and Angiology IIUniversity Heart Center Freiburg-Bad KrozingenBad KrozingenGermany
  2. 2.Section of Cardiovascular Radiology, Department of RadiologyUniversity of FreiburgFreiburg im BreisgauGermany

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