Interventions for valvular disease and heart failure

Predictors and clinical impact of thrombosis after transcatheter mitral valve implantation using balloon-expandable bioprostheses

EuroIntervention 2021;16:1455-1462. DOI: 10.4244/EIJ-D-20-00991

John Kikoïne
John Kikoïne1; Marina Urena1,2,3, MD, PhD; Caroline Chong Nguyen1, MD; Quentin Fischer1, MD; Jose Luis Carrasco4, MD; Eric Brochet1, MD; Grégory Ducrocq1,2,3, MD, PhD; Alec Vahanian3, MD; Bernard Iung1,2,3, MD; Dominique Himbert1,3, MD
1. Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; 2. University of Paris, Paris, France; 3. INSERM U1148, Paris, France; 4. Department of Anesthesiology, Bichat Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France

Aims: The aim of this study was to report the predictors and clinical impact of transcatheter heart valve (THV) thrombosis in patients undergoing transcatheter mitral valve implantation (TMVI).

Methods and results: We included 130 patients who consecutively underwent TMVI. Transoesophageal echocardiography (TOE) and/or computed tomography (CT) were performed in 91.7% of patients at discharge, in 73.3% at three months and in 72% beyond three months. THV thrombosis was defined as the presence of at least one thickened leaflet with restricted motion confirmed by TOE or contrast CT and classified as immediate, early, or late according to the timing of diagnosis. THV thrombosis was observed in 16 (12.3%) patients: immediate in 43.7%, early in 37.5% and late in 18.8%. Most of these thromboses were subclinical (93.7%) and non-obstructive (87.5%). No thromboembolic event occurred. After optimisation of antithrombotic treatment, THV thromboses resolved in all but one patient. Predictors were shock for immediate (p<0.001), male sex for early (p=0.045) and absence of anticoagulation for both early (p=0.018) and late (p=0.023) THV thromboses.

Conclusions: THV thrombosis is frequent after TMVI, occurs mainly within the first three months, is mostly subclinical and resolves after optimisation of antithrombotic treatment. An anticoagulation therapy for at least three months after the procedure is mandatory.

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valve-in-valvemsctimaging modalitiestransthoracic echocardiogramtransoesophageal echocardiogram
Interventions for valvular diseaseMitral valve replacement and repair
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