Thrombosis of TAVI prosthesis—cause for concern or innocent bystander? A comment and review of currently available data

Excerpt

Transcatheter aortic valve implantation (TAVI) has become an established treatment option for severe aortic stenosis in patients at high risk of surgical aortic valve replacement [1, 2]. Recent studies, such as PARTNER-2 [3] and NOTION [4] have expanded the possible use of TAVI to patients at intermediate surgical risk. With increasing life expectancy of patients undergoing TAVI, the issue of valve durability becomes increasingly important. As yet, there is a paucity of data on the antithrombotic regimen following TAVI, although reports on many thousands TAVI procedures have been published [5], demonstrating excellent outcomes in all risk categories [6]. Until recently, much investigated safety issues in TAVI were risk of access vessel complications [7, 8], stroke, or pacemaker implantation, all of which have decreased substantially [9‐12], resulting in an increasing global uptake of the approach. Changes in prosthesis leaflet morphology and function shortly after TAVI only gained interest in 2014, when a review of single case reports identified 16 clinical events of transcatheter valve thrombosis during 2002–2012 [13]. Increasing trans-valvular gradients on echocardiography (from 10 to 42 mmHg) were noted in these patients presented with dyspnea as the most common symptom. Anticoagulation with vitamin K antagonist (warfarin) effectively restored hemodynamics within 2 months. …