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

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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.

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Authors and Affiliations

  1. Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany

    Manuel Hein, Jan Minners, Nikolaus Jander, Philipp Breitbart, Christian Stratz, Franz-Josef Neumann & Philipp Ruile

  2. Section of Cardiovascular Radiology, Department of Radiology, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg im Breisgau, Germany

    Gregor Pache

Authors
  1. Manuel Hein
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  2. Jan Minners
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  3. Nikolaus Jander
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  4. Philipp Breitbart
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  5. Christian Stratz
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  6. Gregor Pache
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  7. Franz-Josef Neumann
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  8. Philipp Ruile
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Corresponding author

Correspondence to Manuel Hein.

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Conflict of interest

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

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Hein, M., Minners, J., Jander, N. et al. Haemodynamic prosthetic valve performance in patients with early leaflet thrombosis after transcatheter aortic valve implantation. Clin Res Cardiol 108, 1017–1024 (2019). https://doi.org/10.1007/s00392-019-01429-7

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  • DOI: https://doi.org/10.1007/s00392-019-01429-7

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