Author + information
- Received April 26, 2019
- Revision received June 25, 2019
- Accepted July 16, 2019
- Published online December 2, 2019.
- Matteo Pagnesi, MDa,
- Francesco Moroni, MDa,
- Alessandro Beneduce, MDa,
- Francesco Giannini, MDb,
- Antonio Colombo, MDb,
- Giora Weisz, MDc,d and
- Azeem Latib, MDc,e,∗ ()
- aCardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
- bInterventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Cotignola, Italy
- cDepartment of Cardiology, Montefiore Medical Center, Bronx, New York
- dCardiovascular Research Foundation, New York, New York
- eDivision of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- ↵∗Address for correspondence:
Dr. Azeem Latib, Department of Cardiology, Montefiore Medical Center, 111 East 210th Street, Bronx, New York 10467.
• The risk of THV thrombosis seems to be relevant after TMVR.
• Routine anticoagulant therapy and serial clinical and imaging follow-up is suggested to mitigate this risk.
• Future dedicated studies are needed to better investigate THV thrombosis and refine antithrombotic strategies after TMVR.
Severe mitral regurgitation (MR) is fairly common in the general population and is associated with significant morbidity and mortality. Although surgical mitral valve (MV) repair and replacement are well established treatment options for MV disease, as much as one-half of patients with severe, symptomatic MR are not referred for surgery due to prohibitive procedural risk. Novel transcatheter alternatives are therefore being developed to provide an alternative treatment for these patients. A growing experience with transcatheter MV replacement (TMVR) strategies is accumulating and promising early results have been reported. However, the risk of transcatheter heart valve (THV) thrombosis seems to be relevant after TMVR, potentially higher than that observed after transcatheter aortic valve replacement, and routine anticoagulant therapy appears to be necessary to mitigate this risk. Hereafter, the authors: 1) review available evidence on thrombotic risk after TMVR (including new dedicated THVs for native MV, valve-in-valve, valve-in-ring, and valve-in-mitral annular calcification); and 2) discuss the antithrombotic treatment strategies after TMVR.
Dr. Latib has served on the advisory board for Medtronic, Abbott Vascular, and Cardiovalve. Dr. Weisz has served on the medical advisory board for Corindus, Eco Fusion, Filterlex, Medivizor, and Trisol; and has received institutional research grants from Abbott Vascular, Corindus, Cardiovascular Systems, Inc., CSL Behring, RenalGuard, and Svelte. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 26, 2019.
- Revision received June 25, 2019.
- Accepted July 16, 2019.
- 2019 American College of Cardiology Foundation
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