title: Valve thrombosis following transcatheter aortic valve implantation: a systematic review.
abstract: OBJECTIVE
  Despite the rapid global uptake of transcatheter aortic valve implantation, valve trombosis has yet to be systematically evaluated in this field. The aim of this study was to determine the clinical characteristics, diagnostic criteria, and treatment outcomes of patients diagnosed with valve thrombosis following transcatheter aortic valve implantation through a systematic review of published data.
  
  
  METHODS
  Literature published between 2002 and 2012 on valve thrombosis as a complication of transcatheter aortic valve implantation was identified through a systematic electronic search.
  
  
  RESULTS
  A total of 11 publications were identified, describing 16 patients (mean age, 80 [5] years, 65% men). All but 1 patient (94%) received a balloon-expandable valve. All patients received dual antiplatelet therapy immediately following the procedure and continued to take either mono- or dual antiplatelet therapy at the time of valve thrombosis diagnosis. Valve thrombosis was diagnosed at a median of 6 months post-procedure, with progressive dyspnea being the most common symptom. A significant increase in transvalvular gradient (from 10 [4] to 40 [12] mmHg) was the most common echocardiographic feature, in addition to leaflet thickening. Thrombus was not directly visualized with echocardiography. Three patients underwent valve explantation, and the remaining received warfarin, which effectively restored the mean transvalvular gradient to baseline within 2 months. Systemic embolism was not a feature of valve thrombosis post-transcatheter aortic valve implantation.
  
  
  CONCLUSIONS
  Although a rare, yet likely under-reported complication of post-transcatheter aortic valve implantation, progressive dyspnea coupled with an increasing transvalvular gradient on echocardiography within the months following the intervention likely signifies valve thrombosis. While direct thrombus visualization appears difficult, prompt initiation of oral anticoagulation therapy effectively restores baseline valve function.
authors: Quebec Heart & Lung Institute, Quebec City, QC, Canada.
authors: Juan G
authors: JG
authors: Córdoba-Soriano
authors: Quebec Heart & Lung Institute, Quebec City, QC, Canada.
authors: Rishi
authors: R
authors: Puri
authors: Quebec Heart & Lung Institute, Quebec City, QC, Canada.
authors: Ignacio
authors: I
authors: Amat-Santos
authors: Quebec Heart & Lung Institute, Quebec City, QC, Canada.
authors: Henrique B
authors: HB
authors: Ribeiro
authors: Quebec Heart & Lung Institute, Quebec City, QC, Canada.
authors: Omar
authors: O
authors: Abdul-Jawad Altisent
authors: Quebec Heart & Lung Institute, Quebec City, QC, Canada.
authors: María
authors: M
authors: del Trigo
authors: Quebec Heart & Lung Institute, Quebec City, QC, Canada.
authors: Jean-Michel
authors: JM
authors: Paradis
authors: Quebec Heart & Lung Institute, Quebec City, QC, Canada.
authors: Eric
authors: E
authors: Dumont
authors: Quebec Heart & Lung Institute, Quebec City, QC, Canada.
authors: Marina
authors: M
authors: Urena
authors: Quebec Heart & Lung Institute, Quebec City, QC, Canada. Electronic address: josep.rodes@criucpq.ulaval.ca.
authors: Josep
authors: J
authors: Rodés-Cabau
mesh_terms: D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D011183:Postoperative Complications; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology*; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*
keywords: Aortic valve stenosis; Estenosis de válvula aórtica; Implante percutáneo de válvula aórtica; Transcatheter aortic valve implantation; Trombosis protésica; Valve thrombosis