Risk Factors for Early HALT after Transfemoral TAVI
DOI:
https://doi.org/10.59958/hsf.7175Keywords:
transcatheter aortic valve implantation, hypoattenuated leaflet thickening, computed tomographyAbstract
Objective: To investigate the risk factors of hypoattenuated leaflet thickening (HALT) in the early stage after transfemoral transcatheter aortic valve implantation (TAVI). Methods: Patients who underwent transfemoral TAVI in the Affiliated Hospital of Qingdao University from January 2021 to June 2023 were selected. According to the results of four-dimensional computed tomography (4DCT), patients were divided into HALT group and non-HALT group. The perioperative data of the two groups were collected to find the risk factors of HALT in the early postoperative period. Results: A total of 100 patients underwent TAVI operation via femoral artery, 2 died after operation, 1 discharged due to cerebral complication, and 2 patients had incomplete 4DCT data. The data of 95 patients were completely collected, including 56 males and 39 females, with an average age of (72.0 ± 6.7) years and a body mass index of (24.0 ± 3.7) kg/m2. 10 patients had HALT, the incidence was 10.5%. 85 patients were in the non-HALT group, including 52 males (61.2%). 10 patients were in the HALT group, 4 cases were male (40%). There were no significant differences in age, sex, body mass index (BMI), hypertension, diabetes, chronic obstructive pulmonary disease (COPD), brain complications, coronary heart disease, left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF) and operation time between the two groups. And the differences between the two groups in perioperative white blood cell, neutrophil, lymphocyte and platelet counts, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and creatinine were not significant. Compared with the non-HALT group, patients in the HALT group had a higher proportion of isolated aortic insufficiency, a lower proportion of post dilatation after valve release, and a higher proportion of valves with skirts. Conclusion: Isolated aortic insufficiency, without post dilatation after valve release, and use of valves with skirt are associated with early HALT after transfemoral TAVI.
References
Cribier A, Eltchaninoff H, Bash A, Borenstein N, Tron C, Bauer F, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation. 2002; 106: 3006–3008.
Pache G, Blanke P, Zeh W, Jander N. Cusp thrombosis after transcatheter aortic valve replacement detected by computed tomography and echocardiography. European Heart Journal. 2013; 34: 3546.
Rosseel L, De Backer O, Søndergaard L. Clinical Valve Thrombosis and Subclinical Leaflet Thrombosis Following Transcatheter Aortic Valve Replacement: Is There a Need for a Patient-Tailored Antithrombotic Therapy? Frontiers in Cardiovascular Medicine. 2019; 6: 44.
Sellers SL, Turner CT, Sathananthan J, Cartlidge TRG, Sin F, Bouchareb R, et al. Transcatheter Aortic Heart Valves: Histological Analysis Providing Insight to Leaflet Thickening and Structural Valve Degeneration. JACC. Cardiovascular Imaging. 2019; 12: 135–145.
Holmes DR, Mack MJ. Uncertainty and Possible Subclinical Valve Leaflet Thrombosis. The New England Journal of Medicine. 2015; 373: 2080–2082.
Rheude T, Pellegrini C, Stortecky S, Marwan M, Xhepa E, Ammon F, et al. Meta-Analysis of Bioprosthetic Valve Thrombosis After Transcatheter Aortic Valve Implantation. The American Journal of Cardiology. 2021; 138: 92–99.
Chakravarty T, Søndergaard L, Friedman J, De Backer O, Berman D, Kofoed KF, et al. Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational study. Lancet (London, England). 2017; 389: 2383–2392.
Makkar RR, Blanke P, Leipsic J, Thourani V, Chakravarty T, Brown D, et al. Subclinical Leaflet Thrombosis in Transcatheter and Surgical Bioprosthetic Valves: PARTNER 3 Cardiac Computed Tomography Substudy. Journal of the American College of Cardiology. 2020; 75: 3003–3015.
Cartlidge TRG, Doris MK, Sellers SL, Pawade TA, White AC, Pessotto R, et al. Detection and Prediction of Bioprosthetic Aortic Valve Degeneration. Journal of the American College of Cardiology. 2019; 73: 1107–1119.
Sannino A, Hahn RT, Leipsic J, Mack MJ, Grayburn PA. Meta-analysis of Incidence, Predictors and Consequences of Clinical and Subclinical Bioprosthetic Leaflet Thrombosis After Transcatheter Aortic Valve Implantation. The American Journal of Cardiology. 2020; 132: 106–113.
Tang L, Lesser JR, Schneider LM, Burns MR, Gössl M, Garberich R, et al. Prospective Evaluation for Hypoattenuated Leaflet Thickening Following Transcatheter Aortic Valve Implantation. The American Journal of Cardiology. 2019; 123: 658–666.
Koo HJ, Choe J, Kang DY, Ko E, Ahn JM, Park DW, et al. Computed Tomography Features of Cuspal Thrombosis and Subvalvular Tissue Ingrowth after Transcatheter Aortic Valve Implantation. The American Journal of Cardiology. 2020; 125: 597–606.
Yanagisawa R, Tanaka M, Yashima F, Arai T, Jinzaki M, Shimizu H, et al. Early and Late Leaflet Thrombosis After Transcatheter Aortic Valve Replacement. Circulation. Cardiovascular Interventions. 2019; 12: e007349.
Jilaihawi H, Asch FM, Manasse E, Ruiz CE, Jelnin V, Kashif M, et al. Systematic CT Methodology for the Evaluation of Subclinical Leaflet Thrombosis. JACC. Cardiovascular Imaging. 2017; 10: 461–470.
Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, et al. Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients. The New England Journal of Medicine. 2019; 380: 1695–1705.
Bogyi M, Schernthaner RE, Loewe C, Gager GM, Dizdarevic AM, Kronberger C, et al. Subclinical Leaflet Thrombosis After Transcatheter Aortic Valve Replacement: A Meta-Analysis. JACC. Cardiovascular Interventions. 2021; 14: 2643–2656.
Pache G, Schoechlin S, Blanke P, Dorfs S, Jander N, Arepalli CD, et al. Early hypo-attenuated leaflet thickening in balloon-expandable transcatheter aortic heart valves. European Heart Journal. 2016; 37: 2263–2271.
Fuchs A, De Backer O, Brooks M, de Knegt MC, Bieliauskas G, Yamamoto M, et al. Subclinical leaflet thickening and stent frame geometry in self-expanding transcatheter heart valves. EuroIntervention: Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2017; 13: e1067–e1075.
Alavi SH, Groves EM, Kheradvar A. The effects of transcatheter valve crimping on pericardial leaflets. The Annals of Thoracic Surgery. 2014; 97: 1260–1266.
Fukui M, Bapat VN, Garcia S, Dworak MW, Hashimoto G, Sato H, et al. Deformation of Transcatheter Aortic Valve Prostheses: Implications for Hypoattenuating Leaflet Thickening and Clinical Outcomes. Circulation. 2022; 146: 480–493.
Bhogal S, Waksman R, Gordon P, Ehsan A, Wilson SR, Levitt R, et al. Subclinical leaflet thrombosis and antithrombotic therapy post-TAVI: An LRT substudy. International Journal of Cardiology. 2023; 371: 305–311.
Midha PA, Raghav V, Sharma R, Condado JF, Okafor IU, Rami T, et al. The Fluid Mechanics of Transcatheter Heart Valve Leaflet Thrombosis in the Neosinus. Circulation. 2017; 136: 1598–1609.
Dangas GD, Tijssen JGP, Wöhrle J, Søndergaard L, Gilard M, Möllmann H, et al. A Controlled Trial of Rivaroxaban after Transcatheter Aortic-Valve Replacement. The New England Journal of Medicine. 2020; 382: 120–129.
Collet JP, Berti S, Cequier A, Van Belle E, Lefevre T, Leprince P, et al. Oral anti-Xa anticoagulation after trans-aortic valve implantation for aortic stenosis: The randomized ATLANTIS trial. American Heart Journal. 2018; 200: 44–50.
Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Revista Espanola De Cardiologia (English Ed.). 2022; 75: 524.
Ruile P, Jander N, Blanke P, Schoechlin S, Reinöhl J, Gick M, et al. Course of early subclinical leaflet thrombosis after transcatheter aortic valve implantation with or without oral anticoagulation. Clinical Research in Cardiology: Official Journal of the German Cardiac Society. 2017; 106: 85–95.
Ferstl P, Achenbach S, Marwan M, Bittner DO. Comparison of oral anticoagulation by vitamin-K antagonists and non-vitamin-K antagonists for treatment of leaflet thickening after transcatheter aortic valve implantation (TAVI). International Journal of Cardiology. 2023; 386: 104–108.
Blanke P, Leipsic JA, Popma JJ, Yakubov SJ, Deeb GM, Gada H, et al. Bioprosthetic Aortic Valve Leaflet Thickening in the Evolut Low Risk Sub-Study. Journal of the American College of Cardiology. 2020; 75: 2430–2442.
