Incidence and associated factor of transcatheter aortic valve prothesis thrombosis in BE-Prostheses and identification of associated factors in a retrospective monocentric database

Martin Geyer (Mainz)1, Y. Yang (Mainz)2, S. Bredeek (Mainz)1, M. Ahoopai (Mainz)1, T. Ruf (Mainz)1, A. R. Tamm (Mainz)1, T. Gößler (Mainz)1, M. A. Rogmann (Mainz)1, M. Oberhoffer (Mainz)3, F. Masseli (Mainz)3, P. Lurz (Mainz)1, R. S. von Bardeleben (Mainz)1

1Universitätsmedizin der Johannes Gutenberg-Universität Mainz Kardiologie 1, Zentrum für Kardiologie Mainz, Deutschland; 2Universitätsmedizin Mainz Klinik für Poliklinik für Diagnostische und Interventionelle Radiologie Mainz, Deutschland; 3Universitätsmedizin Mainz Klinik und Poliklinik für Herz- und Gefäßchirurgie Mainz, Deutschland



While thrombosis is a potential problem with impact on prosthesis durability, data on incidence and predictors is still limited.


Methods and results:

We searched our center’s database for all clinical apparent TAVR-thromboses (apparent by clinical hint and/or elevated gradients in follow-ups and proved by typical morphology of thrombosis in CT-scan) between 1/2018-7/23. 73 Patients (3.0% of the total cohort) were identified with apparent TAVR-thrombosis (43.8% females, mean age 80.2 +/- 6.8 years, mean EuroSCORE II 4.9 +/- 4.3, 4.1% Valve-in-Valve procedure). Of those, 67 (91.2%) were treated with a BE-Prosthesis and entered our analysis. These were compared to a matched control group (n=110, all consecutive patients consecutively treated by TAVR in our site between 1/23 and 6/23 matched for BE-Prosthesis without hint for apparent thrombosis in follow-up).


While no difference in age (p=0.318), female sex (43.3 vs. 37.3%, p=0.434), baseline LVEF (55 (55/59) vs. 55% (46/60), p=0.162) or underlying valve morphology (functional or congenital bicuspidy 29.7 vs. 26.9%, p=0.727) could be detected, patients with later valve thrombosis had a lower risk profile (Euroscore II 3.2 (1.9/5.6) vs. 5.3 (2.6/10.0), p=0.001), were less likely treated with lipid-lowering therapy (59.7 vs. 83.3%, p<0.001) and had smaller anatomies (annular minimal diameter 21.1 (20.1/23.4) vs. 22.3 (20.8/24.1), p=0.021; LVOT area 437 (381/494) vs. 485mm (408/560), p=0.009, area of SOV 810 (688/910) vs 889mm2 (769/1019), p=0.010) including short intraventricular septum (<2 mm, 38.5 vs. 12.5%, p=0.007). No relevant differences in prosthesis-size (p=0.771), administration of Protamine post intervention (40.9 vs. 40.2%, p>0.99) and postprocedural complications (e.g., groin complications 3.0 vs 5.5%, p=0.712) as well as bleedings requiring transfusion within 7 days (6.0 vs. 11.0%, p=0.295) were detected. Nevertheless, there was a trend towards a higher rate of pre-BAV (28.4 vs. 15.5%, p=0.053) and a higher rate of infections during index visit (20.9 vs. 11.9%, p=0.133) in patients with later thrombosis. Of all initial anticoagulant regimen post implantation, patients with thrombosis were mostly not treated with OAC (23.9 vs. 55.5%, p<0.001), whereas no differences regarding treatment with SAPT vs. DAPT (p=0.639) were observed. Medication with OAC post TAVI was strongly associated with lower likelihood for later TAVR-Thrombosis (OR 0.25 (0.13/0.50), p<0.001).


Discussion and Conclusion:

We documented a rather low rate of apparent thrombosis after TAVR-implantation in analogy to previously reported data of other registries. Patients with smaller anatomies, short intraventricular septum length and those without lipid-lowering therapy were more likely to develop TAVR-thrombosis. Postinterventional oral anticoagulation is strongly protective against later prosthesis thrombosis.

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