: Paul Schmitt*
1Department of Cardiology, HIA Sainte Anne Military Hospital, Toulon, France
2Department of Cardiology, HIA Laveran Military Hospital, Marseille, France
3Diving and Hyperbaric Medicine Department, HIA Sainte Anne Military Hospital, Toulon, France
4Flight Crew Medical Expertise Center, HIA Sainte Anne Military Hospital, Toulon, France
Introduction: Over the past decade, Transcatheter Aortic Valve Replacement (TAVR) has become the standard technique for treatment of severe symptomatic aortic stenosis in patients at high or intermediate surgical risk and more recently in low-surgical-risk patients. Although, it is not without potential complications and failure modes, such as endocarditis, structural failure, late embolization, or thrombosis.
Thrombosis can occur as early as within 30 days after valve implantation, and which has led to increased concerns of stroke and long-term valve durability. Clinical thrombosis may have clinical manifestations with recurrence of symptoms and/or increase in trans-prosthetic gradients.
It can also be asymptomatic without trans-prosthetic gradient elevation as revealed by cardiac CT scan showing a thickening of the valvular leaflets or cusp thrombosis, with potential impairment of the valve opening. This greatly underestimated complication has a 10% to 15% incidence.
Aim: Biomechanical factors, intrinsic patient-related predisposition as well as post-TAVR anti-thrombotic treatment have all been incriminated in the occurrence of TAVR thrombosis. While anticoagulation effectively resolves the prosthetic thrombosis, routine use remains controversial and their benefit in the treatment of infraclinical thrombosis has not been clearly established.
Conclusion: We review the pathology, prevalence, diagnosis, hemodynamics, risk factors, prognosis, and treatment of Leaflet Thrombosis (LT), and suggest future directions in this field.
Thrombosis; Prothesis; Antithrombotic; Cardiac computed tomograph
Paul Schmitt. TAVR Thrombosis: A Systematic Review. Int Case Rep Jour. 2022;2(5):1-8.