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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 728-739 |
| Number of pages | 12 |
| Journal | JACC: Cardiovascular Interventions |
| Volume | 8 |
| Issue number | 5 |
| DOIs | |
| State | Published - Apr 27 2015 |
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Keywords
- antiplatelet therapy
- thrombosis
- transcatheter aortic valve replacement
- valve-in-valve
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Thrombus formation following transcatheter aortic valve replacement. / De Marchena, Eduardo; Mesa, Julian; Pomenti, Sydney; Marin Y Kall, Christian; Marincic, Ximena; Yahagi, Kazuyuki; Ladich, Elena; Kutz, Robert; Aga, Yaar; Ragosta, Michael; Chawla, Atul; Ring, Michael E.; Virmani, Renu.
In: JACC: Cardiovascular Interventions, Vol. 8, No. 5, 27.04.2015, p. 728-739.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Thrombus formation following transcatheter aortic valve replacement
AU - De Marchena, Eduardo
AU - Mesa, Julian
AU - Pomenti, Sydney
AU - Marin Y Kall, Christian
AU - Marincic, Ximena
AU - Yahagi, Kazuyuki
AU - Ladich, Elena
AU - Kutz, Robert
AU - Aga, Yaar
AU - Ragosta, Michael
AU - Chawla, Atul
AU - Ring, Michael E.
AU - Virmani, Renu
PY - 2015/4/27
Y1 - 2015/4/27
N2 - 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.
AB - 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.
KW - antiplatelet therapy
KW - thrombosis
KW - transcatheter aortic valve replacement
KW - valve-in-valve
UR - http://www.scopus.com/inward/record.url?scp=84929145059&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84929145059&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2015.03.005
DO - 10.1016/j.jcin.2015.03.005
M3 - Article
C2 - 25946447
AN - SCOPUS:84929145059
VL - 8
SP - 728
EP - 739
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
SN - 1936-8798
IS - 5
ER -