Aortic valve interventions

Silent Valsalva thrombus between the native Valsalva and balloon-expandable transcatheter heart valve: multicentre Japanese registry analysis

EuroIntervention 2019;15:892-899. DOI: 10.4244/EIJ-D-19-00370

Tatsuya Tsunaki
Tatsuya Tsunaki1, RT; Masanori Yamamoto1,2, MD; Tetsuro Shimura1, MD; Ai Kagase2, MD; Toru Naganuma3, MD; Akihiro Higashimori4, MD; Motoharu Araki5, MD; Futoshi Yamanaka6, MD; Kazuki Mizutani7, MD; Yusuke Watanabe8, MD; Toshiaki Otsuka9,10, MD; Ryo Yanagisawa11, MD; Kentaro Hayashida11, MD; OCEAN-TAVI investigators
1. Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan; 2. Department of Cardiology, Nagoya Heart Center, Nagoya, Japan; 3. Department of Cardiology, New Tokyo Hospital, Chiba, Japan; 4. Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan; 5. Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan; 6. Department of Cardiology, Syonan Kamakura General Hospital, Kanagawa, Japan; 7. Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan; 8. Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan; 9. Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan; 10. Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan; 11. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan

Aims: The newly formed geometry between the native Valsalva and implanted transcatheter heart valve (THV) may induce local thrombogenicity. This study aimed to assess the incidence of and the clinical outcomes associated with Valsalva thrombus formation after transcatheter aortic valve implantation (TAVI).

Methods and results: We retrospectively evaluated the multidetector computed tomography (MDCT) data of 338 patients following transcatheter aortic valve implantation (TAVI) using a balloon-expandable THV. The Valsalva and leaflet thrombi were assessed by MDCT at the left coronary cusp (LCC), right coronary cusp (RCC), and non-coronary cusp (NCC). Combined endpoints such as death, stroke, and readmission for heart failure rates in patients with and without Valsalva and/or leaflet thrombus were examined at two years. The overall incidence of Valsalva and leaflet thrombi was 8.9% and 8.3%, respectively. Significant differences in the location of the Valsalva thrombus in the LCC, RCC, and NCC were noted (5.0%, 4.2%, 8.9%, respectively, p<0.001). The independent predictor for increased risk of Valsalva thrombus was high Valsalva area to implanted THV size ratio (odds ratio 11.8, 95% confidence interval [CI]: 1.67-83.0, p=0.013). Combined endpoints were similar in patients with and without Valsalva thrombus, Valsalva/leaflet thrombus, and leaflet thrombus (p>0.05 for all).

Conclusions: Valsalva thrombus was detected in 8.9% of patients following balloon-expandable THV implantation and was common in the LCC, but it did not increase the risk of adverse events after TAVI.

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