Bioprosthetic Valve Thrombosis: Insights from Transcatheter and Surgical Implants

ABSTRACT

Although aortic valve replacement with implantation of a bioprosthesis has been widely performed for more than 50 years, appreciation of the development of bioprosthetic leaflet thrombosis has increased recently with the emergence of transcatheter aortic valve replacement (TAVR) and the use of advanced imaging modalities, such as 4-dimensional computed tomographic angiography. Recent observational and randomized studies have demonstrated how this condition could affect patients treated with either TAVR or surgical aortic valve replacement (SAVR). The clinical relevance of bioprosthetic valve thrombosis and the optimal antithrombotic strategies to prevent this condition in patients treated with SAVR or TAVR are still a matter of debate, while anticoagulation is considered effective treatment to address bioprosthetic valve thrombosis once it is diagnosed. This review provides an overview on timing and mechanism of bioprosthetic valve thrombosis, its prevalence and clinical impact in patients treated with TAVR or SAVR, and how the different designs of various types of bioprostheses could influence the risk of thrombosis.

KEYWORDS:

• Bioprosthetic valve thrombosis
• hypoattenuated leaflet thickening
• TAVR
• SAVR

Disclosure statement

Dr. Makkar has received research grants from Edwards Lifesciences and Abbott, and is a consultant for Cordis and Medtronic. Dr. Leipsic has been a consultant for and holds stock in Circle Cardiovascular Imaging and HeartFlow and provides core lab services for NIH, Edwards Lifesciences, Neovasc, Abbott, and Medtronic. He has also been a member of the Speakers Bureau for GE Healthcare and Edwards LifeSciences, received research support from GE Healthcare and grant support from the Canadian Institutes of Health Research (CIHR), National Institutes of Health (NIH), GE Healthcare and HeartFlow. Dr. Leipsic is an associate editor of Structural Heart. Dr. Batchelor is a consultant for Boston Scientific, Abbott, and V-Wave. Dr. Poppas holds individual stock in GE. Dr. Mack has nonfinancial relationships with industry as the co-PI of the PARTNER 3 Trial (Edwards), study chair of the APOLLO Trial (Medtronic), and co-PI of the COAPT Trial (Abbott). Dr. Leon reports institutional grants for clinical research from Abbott, BSC, Edwards, and Medtronic. Dr. Thourani is a consultant for Abbott, Allergen, Boston Scientific, Cryolife, Edwards Lifesciences, Gore, and Jenavalve. Dr. Carroll is a local investigator in TAVR clinical trials sponsored by Edwards LifeSciences and Medtronic. Dr. Dangas reports research grants from Bayer and Daiichi-Sankyo and consultant (spouse): Boston Scientific, Janssen. The other authors have no disclosures to report.

Additional information

Funding

The authors have no funding to report for this review.