RT Journal Article
SR Electronic
T1 Coagulation derangement and risk factors for valve thrombosis following transcatheter aortic valve implantation
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e001496
DO 10.1136/openhrt-2020-001496
VO 8
IS 1
A1 Tiffany Patterson
A1 Harriet Hurrell
A1 Jack Lee
A1 Giulia Esposito
A1 Utkarsh Dutta
A1 Julia Grapsa
A1 Nicholas Aroney
A1 Fiyyaz Ahmed-Jushuf
A1 Christopher Allen
A1 Ronak Rajani
A1 Rebecca Preston
A1 Christopher Young
A1 Gianluca Lucchese
A1 Kiran Parmar
A1 Beverley Hunt
A1 Bernard D Prendergast
A1 Simon R Redwood
YR 2021
UL http://openheart.bmj.com/content/8/1/e001496.abstract
AB Aims Durability of transcatheter aortic valve implantation (TAVI) is key to its expansion. We sought to identify incidence of valve thrombosis and predictors of valve thrombosis in our single centre with associated coagulation testing pre-TAVI and post-TAVI.Methods and results This single-centre observational study comprised patients undergoing transfemoral TAVI discussed in the Heart Team meeting . Patients were followed up with echocardiography at 120 days to identify incidence of elevated transvalvular gradient and multivariable analysis was performed to identify factors associated with an increased odds of developing valve thrombosis. In addition, 11 patients underwent baseline, day 1 and day 120 post-TAVI coagulation testing. Between August 2017 and August 2019, 437 consecutive patients underwent transfemoral TAVI. Of these patients, 207/437 (47.4%) had 3-month follow-up echo data available and were analysed. Of these patients, 26/207 (12.6%) had elevated transvalvular gradients. These patients tended to be younger (80±14 vs 83±6 years; p=0.047) with a lower ejection fraction (49±13 vs 54%±11%; p=0.021), with a greater proportion of the population experiencing atrial fibrillation (14/21, 54% vs 68/181, 38%; p=0.067). Following multivariable analysis, there remained a trend towards higher eccentricity index associated with elevated gradients. Baseline (pre-TAVI) elevation of thrombin antithrombin levels (56±63; reference range 1.0–4.1 ng/L) and PF 1+2 (791±632; reference range 69–229 ng/mL) normalised at 120 days post-TAVIConclusion This study demonstrated that in the cohort of patients undergoing transfemoral TAVI in our centre: younger age, poor ejection fraction, atrial fibrillation and increased baseline eccentricity of the aortic valve annulus were present to a greater extent in patients exhibiting elevated transvalvular gradients at 3-month follow-up. Further work is required to delineate the extent of coagulation derangement and confirm predictors of thrombosis.All data relevant to the study are included in the article or uploaded as online supplemental information.