Nearly one-third of patients who undergo surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) develop hypoattenuated leaflet thickening (HALT) within a year. HALT typically represents subclinical leaflet thrombosis in asymptomatic patients, and as a result it often is detected incidentally. However, HALT also may worsen in severity, resulting in leaflet immobility and/or valve deterioration. The clinical significance of HALT is a topic of ongoing debate, and currently there is no consensus on the screening and management of HALT in patients following TAVR or SAVR. This review provides a comprehensive evaluation of the available evidence on risk factors, preventative measures, treatment, and prognosis for this growing patient cohort.
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http://dx.doi.org/10.1053/j.jvca.2024.06.043 | DOI Listing |
Cardiovasc Interv Ther
January 2025
Division of Cardiology, Department of Medicine, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan.
Transcatheter aortic valve implantation (TAVI) using the NAVITOR system has been relatively underreported due to its recent introduction in Japan. This study aimed to assess the short-term outcomes of TAVI with the NAVITOR in real-world clinical practice. Patients with severe aortic stenosis who underwent TAVI using the NAVITOR system at our institution between December 2022 and December 2023 were prospectively enrolled.
View Article and Find Full Text PDFCatheter Cardiovasc Interv
January 2025
Cardiology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
Transcatheter aortic valve replacement (TAVR) is a well-established treatment for severe aortic stenosis, especially in patients over 75 or those at high surgical risk. While these prosthetic valves have a lower thrombogenic profile than mechanical heart valves, leaflet thrombosis in transcatheter aortic valves (TAV) occurs in an estimated 5%-40% of cases. Most TAV thromboses are subclinical and can be detected via cardiac computed tomography (CCT), which reveals hypo-attenuating leaflet thickening and reduced leaflet motion in asymptomatic patients without elevated transprosthetic gradients on echocardiography.
View Article and Find Full Text PDFInt J Cardiol
December 2024
Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. Electronic address:
Leaflet thrombosis after transcatheter aortic valve replacement (TAVR) presents a significant challenge, leading to adverse clinical outcomes. Subclinical leaflet thrombosis (SLT) is increasingly recognized, and there is a growing concern about its role in clinical events and hemodynamic valve deterioration. Current recommendations for prophylactic anticoagulation or antiplatelet therapy following TAVR are primarily based on expert consensus rather than definitive evidence from randomized trials, resulting in a variety of antithrombotic strategies in clinical practice.
View Article and Find Full Text PDFCatheter Cardiovasc Interv
December 2024
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Background: Hypoattenuating leaflet thickening (HALT) following transcatheter aortic valve replacement (TAVR) may compromise valve durability, posing a significant barrier to the broader adoption of this technology among younger patients. Self-expanding valves (SEVs) are the most commonly used transcatheter heart valves (THVs) among Chinese patients with aortic stenosis. Understanding the potential mechanisms underlying HALT is, therefore, critical to guide future THV design and development.
View Article and Find Full Text PDFEur J Cardiothorac Surg
December 2024
Department of Cardiac Surgery, LMU University Hospital, Munich, Germany.
Objectives: In this retrospective study, we aimed to assess incidence, possible causes and clinical consequences of hypoattenuated leaflet thickening (HALT) following aortic root replacement with valved composite grafts and concomitant aortic arch repair.
Methods: Between January 2016 and December 2022, 454 patients underwent Bentall procedures with arch replacements in hypothermic circulatory arrest at the University Aortic Centre MunichLMU, Germany. Sequential postoperative ECG-gated, high-resolution computed tomography angiographies were analyzed, and the presence of HALT correlated with neurologic events and transvalvular gradients over time.
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