Author + information
- Received December 22, 2017
- Revision received February 26, 2018
- Accepted April 3, 2018
- Published online June 18, 2018.
- Philipp Ruile, MDa,∗ (, )
- Jan Minners, MDa,
- Philipp Breitbart, MDa,
- Simon Schoechlin, MDa,
- Michael Gick, MDa,
- Gregor Pache, MDb,
- Franz-Josef Neumann, MDa and
- Manuel Hein, MDa
- aDepartment of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
- bDepartment of Radiology, Section of Cardiovascular Radiology, University of Freiburg, Freiburg, Germany
- ↵∗Address for correspondence:
Dr. Philipp Ruile, Clinic for Cardiology II, University Heart Center, Südring 15, 79189 Bad Krozingen, Germany.
Objectives The aim of this study was to investigate medium-term outcomes in patients with leaflet thrombosis (LT).
Background The clinical significance of early LT after transcatheter aortic valve replacement, diagnosed by computed tomography angiography in approximately 10% of patients, is uncertain.
Methods In this observational study, computed tomographic angiography was performed a median of 5 days after transcatheter aortic valve replacement and assessed for evidence of LT. Follow-up consisted of clinical visits, telephone contact, or questionnaire.
Results LT was diagnosed in 120 of 754 patients (15.9%). Patients with LT were less likely male (36.7% vs. 47.0%, p = 0.045), with a lower rate of atrial fibrillation (28.3% vs. 41.5%, p = 0.008). Peri- and post-procedural characteristics were comparable between groups (e.g., valve implantation technique; p = 0.116). During a median follow-up period of 406 days, there were no significant differences in the primary endpoint of all-cause mortality and the secondary combined endpoint of stroke and transient ischemic attack between patients with LT and those without LT (18-month Kaplan-Meier estimate for mortality 86.6% vs. 85.4%, p = 0.912; for stroke- or transient ischemic attack–free survival 98.5% vs. 96.8%, p = 0.331). In univariate and multivariate analyses, LT was not predictive of either endpoint, whereas male sex (p = 0.03), atrial fibrillation (p = 0.002), and more than mild paravalvular leak (p = 0.015) were associated with all-cause mortality.
Conclusions In this prospective observational cohort undergoing post–transcatheter aortic valve replacement computed tomographic angiography, LT was not associated with increased mortality or rates of stroke over a follow-up period of 406 days.
Dr. Pache is a consultant for Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 22, 2017.
- Revision received February 26, 2018.
- Accepted April 3, 2018.
- 2018 American College of Cardiology Foundation
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