Thrombus formation following transcatheter aortic valve replacement.
OBJECTIVES
This paper reviews the published data and reports 3 cases of thrombosis involving CoreValve (Medtronic, Minneapolis, Minnesota) and 1 involving Edward Sapien (Edwards Lifesciences, Irvine, California) devices. Three of these cases had pathological findings at autopsy.


BACKGROUND
Only a limited number of cases of valve dysfunction with rapid increase of transvalvular aortic gradients or aortic insufficiency post-transcatheter aortic valve replacement (TAVR) have been described. This nonstructural valvular dysfunction has been presumed to be because of early pannus formation or thrombosis.


METHODS
Through reviews of the published reports and 4 clinical cases, pathological and clinical findings of early valve thrombosis are examined to elucidate methods for recognition and identifying potential causes and treatments.


RESULTS
This paper presents 4 cases, 2 of which had increasing gradients post-TAVR. All 3 pathology cases showed presence of a valve thrombosis in at least 2 TAV leaflets on autopsy, but were not visualized by transthoracic echocardiogram or transesophageal echocardiogram. One case was medically treated with oral anti coagulation with normalization of gradients. The consequence of valve thrombosis in all 3 pathology patients either directly or indirectly played a role in their early demise. At least 18 case reports of early valve thrombosis have been published. In 12 of these cases, the early treatment with anticoagulation therapy resolved the thrombus formation and normalized aortic pressures gradients successfully.


CONCLUSIONS
These 4 cases elucidate the occurrence of valve thrombosis post-TAVR. Consideration should be given to treatment with dual antiplatelet therapy and oral anticoagulation in patients post-TAVR with increasing mean pressure gradients and maximum aortic valve velocity. Further research should be conducted to create guidelines for antithrombotic therapy following TAVR procedure.
['De Marchena|Eduardo|E|', 'Mesa|Julian|J|', 'Pomenti|Sydney|S|', 'Marin Y Kall|Christian|C|', 'Marincic|Ximena|X|', 'Yahagi|Kazuyuki|K|', 'Ladich|Elena|E|', 'Kutz|Robert|R|', 'Aga|Yaar|Y|', 'Ragosta|Michael|M|', 'Chawla|Atul|A|', 'Ring|Michael E|ME|', 'Virmani|Renu|R|']
D000284:Administration, Oral D000368:Aged D000369:Aged, 80 and over D000925:Anticoagulants D001021:Aortic Valve D001024:Aortic Valve Stenosis D001344:Autopsy D002114:Calcinosis D006328:Cardiac Catheterization D017809:Fatal Outcome D005260:Female D006350:Heart Valve Prosthesis D019918:Heart Valve Prosthesis Implantation D006439:Hemodynamics D006801:Humans D008297:Male D011474:Prosthesis Design D011859:Radiography D012307:Risk Factors D013927:Thrombosis D016896:Treatment Outcome
transcatheter aortic valve replacement thrombosis antiplatelet therapy valve-in-valve