PMID- 32633055
OWN - NLM
STAT- MEDLINE
DCOM- 20210924
LR  - 20210924
IS  - 1522-726X (Electronic)
IS  - 1522-1946 (Linking)
VI  - 97
IP  - 3
DP  - 2021 Feb 15
TI  - Bioprosthetic valve oversizing is associated with increased risk of valve 
      thrombosis following TAVR.
PG  - E411-E417
LID - 10.1002/ccd.29104 [doi]
AB  - BACKGROUND: Hypoattenuating leaflet thickening (HALT), the radiographic 
      manifestation of transcatheter heart valve thrombosis, is commonly identified 
      following transcatheter aortic valve replacement (TAVR) and associated with 
      increased risk of stroke and structural valve deterioration. While 
      anticoagulation effectively resolves HALT, routine use remains controversial. We 
      aimed to identify hemodynamic, anatomic, and comorbid predictors of HALT. 
      METHODS: We evaluated consecutive patients with severe aortic stenosis who 
      underwent TAVR with Edwards SAPIEN 3 bioprosthesis at a single center between 
      June 1, 2018 and October 30, 2019. Patients on anticoagulation and those 
      receiving valve-in-valve were excluded. Clinically driven computed tomography 
      (CT) imaging was performed to assess for HALT at the discretion of the treating 
      valve team. RESULTS: A total of 78 patients with a mean age of 78 +/- 10 years and 
      STS risk score 5.5 +/- 3.3% were analyzed. HALT was identified in 11 (14.1%) 
      patients. Compared to controls, those with HALT had smaller annular areas, 
      435 +/- 57 mm(2) vs. 489 +/- 79 mm(2) (p = .032), but received comparable size 
      valves. In multivariate regression, valve oversizing by more than 20% was 
      associated with increased risk of HALT, OR 23.5, 95% CI 2.5-223, (p = .006). 
      After initiation of anticoagulation, patients with HALT had similar rates of 
      stroke, major bleeding, and all-cause mortality out to an average of 243 days. 
      CONCLUSIONS: In this pragmatic study of patients undergoing TAVR with SAPIEN 3 
      valves, we report the novel finding that oversizing by more than 20% was 
      independently associated with increased risk of HALT. These findings warrant 
      confirmation in larger and prospective trials.
CI  - (c) 2020 Wiley Periodicals LLC.
FAU - Simpson, Timothy F
AU  - Simpson TF
AUID- ORCID: 0000-0002-8580-0773
AD  - Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon 
      Health & Science University, Portland, Oregon, USA.
FAU - Tuohy, Craig V
AU  - Tuohy CV
AD  - Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon 
      Health & Science University, Portland, Oregon, USA.
FAU - Rajotte, Katherine
AU  - Rajotte K
AD  - Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon 
      Health & Science University, Portland, Oregon, USA.
FAU - Golwala, Harsh
AU  - Golwala H
AD  - Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon 
      Health & Science University, Portland, Oregon, USA.
FAU - Fuss, Cristina
AU  - Fuss C
AD  - Department of Diagnostic Radiology, Oregon Health & Science University, Portland, 
      Oregon, USA.
FAU - Song, Howard K
AU  - Song HK
AD  - Division of Cardiothoracic Surgery, Knight Cardiovascular Institute, Oregon 
      Health & Science University, Portland, Oregon, USA.
FAU - Zahr, Firas
AU  - Zahr F
AUID- ORCID: 0000-0001-8448-8880
AD  - Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon 
      Health & Science University, Portland, Oregon, USA.
FAU - Chadderdon, Scott M
AU  - Chadderdon SM
AD  - Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon 
      Health & Science University, Portland, Oregon, USA.
LA  - eng
PT  - Journal Article
DEP - 20200706
PL  - United States
TA  - Catheter Cardiovasc Interv
JT  - Catheterization and cardiovascular interventions : official journal of the 
      Society for Cardiac Angiography & Interventions
JID - 100884139
SB  - IM
MH  - Aortic Valve/diagnostic imaging/surgery
MH  - *Aortic Valve Stenosis/diagnostic imaging/surgery
MH  - *Heart Valve Prosthesis/adverse effects
MH  - Humans
MH  - Prospective Studies
MH  - Prosthesis Design
MH  - *Thrombosis/diagnostic imaging/etiology
MH  - *Transcatheter Aortic Valve Replacement/adverse effects
MH  - Treatment Outcome
OTO - NOTNLM
OT  - aortic valve stenosis
OT  - bioprosthesis
OT  - thrombosis
OT  - transcatheter aortic valve replacement
EDAT- 2020/07/08 06:00
MHDA- 2021/09/25 06:00
CRDT- 2020/07/08 06:00
PHST- 2020/05/12 00:00 [received]
PHST- 2020/06/07 00:00 [accepted]
PHST- 2020/07/08 06:00 [pubmed]
PHST- 2021/09/25 06:00 [medline]
PHST- 2020/07/08 06:00 [entrez]
AID - 10.1002/ccd.29104 [doi]
PST - ppublish
SO  - Catheter Cardiovasc Interv. 2021 Feb 15;97(3):E411-E417. doi: 10.1002/ccd.29104. 
      Epub 2020 Jul 6.