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Current prevalence of thrombus formation after transcatheter aortic valve replacement (TAVR) is small (1-3%). This complication can lead to poor clinical outcomes including re-do procedure and cardiac death. Currently there are no established diagnostic or treatment guidelines. We aimed to report the clinical presentation, diagnosis, treatment and outcomes of all cases described on literature for post-TAVR thrombosis.
We systematically search Pub Med, Embase and Cochrane database through June 2016 for all cases described for post-TAVR thrombosis. We reported patient’s age and sex, type and size of valve used, type of anti-platelet regimen post TAVR, time since TAVR implantation, clinical presentation upon diagnosis of thrombosis, mean peak gradient, treatment used and clinical outcomes.
A total of 19 studies reported a total of 27 cases of post-TAVR thrombosis. Mean age was 79±7 years, 56% were men, mean time since TAVR was 9.3±14 months. Most of them were discharged on dual anti-platelet therapy (63%). Majority of them presented with NYHA class III (65%) upon diagnosis. Imaging diagnosis (Echo or chest CT) disclosed restricted leaflets in 80%. Diagnostic echocardiogram disclosed mean peak gradient of 44±16.6 mmHg. The majority of them were treated with oral-anti-coagulant (60%). Follow up echo disclosed mean gradient 11.2 ±4.78 mmHg. There were 6 deaths (22%), 2 required surgery (7%) and one re-do TAVR (3%).
Post-TAVR thrombosis is an uncommon complication that can be initially under diagnosed. Majority of these patients present symptomatic with decreased leaflet mobility and increased mean peak gradient. Oral anti-coagulant can lead to clinical improvement. There is high mortality rate. Further studies for diagnosis and treatment should be pursued.