Valve thrombosis after transcatheter mitral valve implantation - 09/01/21
Résumé |
Background |
Transcatheter mitral valve implantation (TMVI) is a new treatment option for high-risk surgical patients with degenerated bioprosthesis (ViV), failed annuloplasty rings (ViR) and severe mitral annular calcification (ViMAC). However, limited data exist on transcatheter heart valve (THV) thrombosis.
Purpose |
To report the incidence, clinical impact and treatment outcomes of THV thrombosis in patients undergoing TMVI.
Methods |
All consecutive patients underwent TMVI in our center between July 2010 and September 2019 were included. A transoesophageal echocardiography (TOE) and a computed tomography (CT) were performed at discharge and each follow-up clinical visit (3 months, 1 year and then annually). THV thrombosis was defined as the presence of at least one thickened leaflet with restricted motion confirmed by TOE and/or contrast CT, and was classified according to the timing of diagnosis as immediate (at discharge), early (at the 3-month clinical visit), or late (at the 1-year clinical visit and thereafter) (Table 1).
Results |
A total of 132 patients underwent TMVI. At a median follow-up of 1.4 years, THV thrombosis was observed in 16 (12.1%) patients: 7 (43.8%) in the ViV TMVI group, 5 (31.2%) in the ViR group and 4 (25%) in the ViMAC group (P=0.93). In 13 (81.2%) patients, THV thrombosis occured within the first 3 months. Neither stroke nor other thromboembolic event occurred. Rates of early and late THV thrombosis were higher in patients without anticoagulation than in those treated with anticoagulation (respectively 25% vs.3.2%, p=0.018 and 13.6% vs.0%, P=0.023). After optimization of antithrombotic treatment, THV thrombosis resolved in all but one asymptomatic patient (Fig. 1).
Conclusions |
THV thrombosis is frequent after TMVI, occurs mainly within the first 3 months, is mostly subclinical and resolves after optimization of antithrombotic treatment. An anticoagulation therapy for at least 3 months after the procedure is mandatory.
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Vol 13 - N° 1
P. 70-71 - janvier 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.