title: Early hypo-attenuated leaflet thickening in balloon-expandable transcatheter aortic heart valves.
abstract: We sought to evaluate the frequency of early hypo-attenuated leaflet thickening (HALT) of the SAPIEN 3 transcatheter aortic valve (S3).
  
  
  
  Of 249 patients who had undergone S3 implantation, we studied 156 consecutive patients (85 women, median age 82.2 ± 5.5 years) by electrocardiogram (ECG)-triggered dual-source computed tomography angiography (CTA) after a median of 5 days post-transcatheter aortic valve implantation. The prosthesis was assessed for HALT. Apart from heparin, peri-interventional antithrombotic therapy consisted of single- (aspirin 29%) or dual- (aspirin plus clopidogrel 71%) antiplatelet therapy. Hypo-attenuated leaflet thickening was found in 16 patients [10.3% (95% confidence interval (CI) 5.5-15.0%)] of the patients. None of the baseline and procedural variables were significantly associated with HALT, nor did we find a significant association with the antithrombotic regimen, either peri-interventionally or at the time of CTA. Hypo-attenuated leaflet thickening was found in 6 of 45 patients with peri-interventional single-antiplatelet therapy and in 10 of 111 patients with dual-antiplatelet therapy at the time of intervention [13.3% (95% CI 3.4-23.3%) vs. 9% (95% CI 3.7-14.3%), P = 0.42]. Hypo-attenuated leaflet thickening was not associated with clinical symptoms, but a small, albeit significant difference in mean pressure gradient at the time of CTA (11.6 ± 3.4 vs. 14.9 ± 5.3 mmHg, P = 0.026). Full anticoagulation led to almost complete resolution of HALT in 13 patients with follow-up CTA.
  
  
  
  Irrespective of the antiplatelet regimen, early HALT occurred in 10% of our patients undergoing transcatheter aortic S3 implantation. Early HALT is clinically inapparent and reversible by full anticoagulation.
authors.affiliation: Department of Radiology, Section of Cardiovascular Radiology, University of Freiburg, Südring15, Bad Krozingen 79189, Germany gregor.pache@universitaets-herzzentrum.de.
authors.forename: Gregor
authors.initials: G
authors.lastname: Pache
authors.affiliation: Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Schoechlin
authors.affiliation: Center for Heart Valve Innovation, St. Paul's Hospital & University of British Columbia, Vancouver, Canada.
authors.forename: Philipp
authors.initials: P
authors.lastname: Blanke
authors.affiliation: Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Dorfs
authors.affiliation: Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Jander
authors.affiliation: Center for Heart Valve Innovation, St. Paul's Hospital & University of British Columbia, Vancouver, Canada.
authors.forename: Chesnal D
authors.initials: CD
authors.lastname: Arepalli
authors.affiliation: Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Gick
authors.affiliation: Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Heinz-Joachim
authors.initials: HJ
authors.lastname: Buettner
authors.affiliation: Center for Heart Valve Innovation, St. Paul's Hospital & University of British Columbia, Vancouver, Canada.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.affiliation: Department of Radiology, Section of Cardiovascular Radiology, University of Freiburg, Südring15, Bad Krozingen 79189, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Langer
authors.affiliation: Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
authors.affiliation: Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Ruile
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome
keywords: Computed tomography; Leaflet thickening; Sapien 3; TAVI; Transcatheter heart valve