The following is a summary of “Impact of leaflet thrombosis on valve hemodynamic status after transcatheter aortic valve replacement,” published in the August 2023 issue of Cardiology by Jang et al.
The impact of hypoattenuated leaflet thickening (HALT) on bioprosthetic valve function and durability is unknown. Researchers performed a retrospective study to evaluate the impact of HALT on valve function after transcatheter aortic valve replacement (TAVR) and the risk factors for structural valve deterioration (SVD).
The study compared edoxaban with dual antiplatelet therapy in patients with successful TAVR. They assessed the presence of HALT using specialized imaging at 6 months and serial echocardiography. They defined SVD as meeting at least one of the following criteria a mean transprosthetic gradient of ≥20 mm Hg, a change in mean gradient of ≥10 mm Hg from baseline, or the development or worsening of intraprosthetic aortic regurgitation by at least one grade, resulting in moderate or more significant regurgitation.
The reported outcome was HALT detection in 30 out of 211 patients (14.2%). The presence of HALT did not significantly impact aortic valve mean gradients at 6 months (with vs without HALT; 14.0±4.8 mm Hg vs 13.7±5.5 mm Hg; P=0.74). SVD occurred in 30 out of 206 patients (14.6%) during the 6-month echocardiography follow-up. Factors linked to hemodynamic SVD included older age (OR: 1.138; 95% CI: 1.019 to 1.293; P=0.033), use of aortic valve size ≤23 mm (OR: 6.254; 95% CI: 2.230 to 20.569; P=0.001), and mean post-TAVR pressure gradient (OR: 1.233; 95% CI: 1.123 to 1.371; P<0.001). The presence of HALT was not identified as a predictor of SVD.
The study found that HALT did not affect valve function in TAVR patients, but longer-term follow-up is needed to assess its impact on durability.