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Reduced Leaflet motion (RLM) of transcatheter aortic valves (TAV) is observed in up to 4% of cases, with an incidence that differs based on prosthesis type and size. This phenomenon likely represents subclinical leaflet thrombosis. Herein we sought to analyze the existing reported literature to assess whether or not RLM is associated with subsequent valve degeneration or cerebrovascular events.
Methods and Results
We searched PubMed, and EMBASE (2008-2017) to identify relevant studies. Studies with less than 1-year follow-up, studies not evaluating RLM, and studies not evaluating neurological events and/or structural valvular degeneration were excluded. Our co-primary endpoints were the incidence of cerebrovascular events (stroke and/or transient ischemic attacks) or structural valvular degeneration defined as moderate or greater regurgitation and/or a mean gradient ≥ 20 mm Hg. The literature search yielded 20 potential studies. Of these, 4 observational studies with a total population of 1,005 patients met our selection criteria. RLM was associated with an increased risk of stroke or TIA (adjusted OR 2.29, 95% CI 1.31 to 3.99, p = 0.004). At 1 year, RLM was associated with an increased risk of structural valve degeneration (adjusted OR 4.62, 95% CI 2.23 to 9.57, p = 0.006).
In TAVR patients, presence of RLM is associated with increased risk of stroke or TIA as well as structural valvular degeneration. These findings support ongoing surveillance efforts and evaluation of pharmacotherapies to address RLM in effort to minimize subsequent clinical events.