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The prevalence of computed tomography‐defined leaflet thrombosis in intra‐ versus supra‐annular transcatheter aortic valve prostheses
Author(s) -
Rashid Hashrul N.,
Nasis Arthur,
Gooley Robert P.,
Cameron James D.,
Brown Adam J.
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27702
Subject(s) - medicine , thrombus , valve replacement , thrombosis , cohort , cardiology , bicuspid aortic valve , aortic valve , computed tomography , surgery , radiology , stenosis
Leaflet thrombosis (LT) defined by computed tomography (CT) following transcatheter aortic valve replacement (TAVR) has been shown to increase cerebrovascular events. The neo‐sinus plays an important role in the development of LT. Intra‐annular valves (IAV) have a larger neo‐sinus when compared to supra‐annular valves (SAV), and has been associated with larger thrombus burden. The prevalence of LT with IAV and SAV in a larger, diverse cohort is unknown. Methods We performed a systematic review to assess the prevalence of LT in IAV versus SAV TAVR prostheses. Inclusion criteria were (1) reported CT‐defined LT following TAVR, (2) comparison between LT and non‐LT cohort, (3) separate registry/database, and (4) fully published status. A total of 2,013 citations were reviewed and 7 studies were included. Results Overall, 1,644 patients were included from 7 observational studies and the prevalence of LT following TAVR was 12.8%. The Portico valve system (IAV) had the highest prevalence of LT with 35.2%, followed by Symetis Acurate Neo (SAV) at 15.4% and the Lotus valve system (IAV) at 14.5%. LT occurred more frequently in IAV than SAV (13.5% vs. 7%, P = 0.02). Subanalysis of IAV versus SAV with the exclusion of the Portico valve was performed to ensure results were not influenced by this valve system and revealed IAV still had higher rates of LT (12.1% vs. 7%, P = 0.05). Conclusion In summary, IAV prostheses appear to be associated with higher rates of LT when compared with SAV.