title: Transcatheter Aortic Valve Thrombosis: Incidence, Predisposing Factors, and Clinical Implications.
abstract: There are limited data on the incidence, clinical implications, and predisposing factors of transcatheter heart valve (THV) thrombosis following transcatheter aortic valve replacement (TAVR).
  
  
  
  The authors assessed the incidence, potential predictors, and clinical implications of THV thrombosis as determined by contrast-enhanced multidetector computed tomography (MDCT) after TAVR.
  
  
  
  Among 460 consecutive patients who underwent TAVR with the Edwards Sapien XT or Sapien 3 (Edwards Lifesciences, Irvine, California) THV, 405 (88%) underwent MDCT in addition to transthoracic and transesophageal echocardiography 1 to 3 months post-TAVR. MDCT scans were evaluated for hypoattenuated leaflet thickening that indicated THV thrombosis.
  
  
  
  MDCT verified THV thrombosis in 28 of 405 (7%) patients. A total of 23 patients had subclinical THV thrombosis, whereas 5 (18%) patients experienced clinically overt obstructive THV thrombosis. THV thrombosis risk did not differ among different generations of THVs (8% vs. 6%; p = 0.42). The risk of THV thrombosis in patients who did not receive warfarin was higher compared with patients who received warfarin (10.7% vs. 1.8%; risk ratio [RR]: 6.09; 95% confidence interval [CI]: 1.86 to 19.84). A larger THV was associated with an increased risk of THV thrombosis (p = 0.03). In multivariable analysis, a 29-mm THV (RR: 2.89; 95% CI: 1.44 to 5.80) and no post-TAVR warfarin treatment (RR: 5.46; 95% CI: 1.68 to 17.7) independently predicted THV thrombosis. Treatment with warfarin effectively reverted THV thrombosis and normalized THV function in 85% of patients as documented by follow-up transesophageal echocardiography and MDCT.
  
  
  
  Incidence of THV thrombosis in this large study was 7%. A larger THV size may predispose to THV thrombosis, whereas treatment with warfarin appears to have a protective effect. Although often subclinical, THV thrombosis may have important clinical implications.
authors: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: nh@dadlnet.dk.
authors: Nicolaj C
authors: NC
authors: Hansson
authors: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
authors: Erik L
authors: EL
authors: Grove
authors: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors: Henning R
authors: HR
authors: Andersen
authors: Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Jonathon
authors: J
authors: Leipsic
authors: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors: Ole N
authors: ON
authors: Mathiassen
authors: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors: Jesper M
authors: JM
authors: Jensen
authors: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors: Kaare T
authors: KT
authors: Jensen
authors: Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Philipp
authors: P
authors: Blanke
authors: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors: Tina
authors: T
authors: Leetmaa
authors: Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark.
authors: Mariann
authors: M
authors: Tang
authors: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors: Lars R
authors: LR
authors: Krusell
authors: Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark.
authors: Kaj E
authors: KE
authors: Klaaborg
authors: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors: Evald H
authors: EH
authors: Christiansen
authors: Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark.
authors: Kim
authors: K
authors: Terp
authors: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors: Christian J
authors: CJ
authors: Terkelsen
authors: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors: Steen H
authors: SH
authors: Poulsen
authors: Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors: John
authors: J
authors: Webb
authors: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
authors: Hans Erik
authors: HE
authors: Bøtker
authors: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors: Bjarne L
authors: BL
authors: Nørgaard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D003718:Denmark / Q000453:epidemiology; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D061330:Multidetector Computed Tomography; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*
keywords: aortic stenosis; multidetector computed tomography; platelet aggregation inhibitors; transcatheter aortic valve replacement; warfarin