Bioprosthetic Valve Thrombosis

• Published in: Journal of the American College of Cardiology Vol. 69; no. 17; pp. 2193 - 2211
• Main Authors: Puri, Rishi, Auffret, Vincent, Rodés-Cabau, Josep
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 02.05.2017; Elsevier Limited; Elsevier
• Subjects: 4-dimensional computed tomography; Age; Animals; Aorta; Aortic valve; Aspirin; Autografts; Autopsy; Bioengineering; Bioprosthesis - adverse effects; Bleeding; Blood clots; Blood flow; Bone grafts; Cadavers; Calcification; Calcification (ectopic); Cardiology and cardiovascular system; Cardiovascular; Cardiovascular disease; Catheters; Chest; Chromium; Clinical medicine; Clotting; Cobalt; Collagen; Computed tomography; Coronary artery disease; Cryopreservation; Demography; Health care delivery; Heart; Heart diseases; heart valve prosthesis; Heart Valve Prosthesis - adverse effects; Heart Valve Prosthesis Implantation; Human health and pathology; Humans; Infections; Life Sciences; Patients; Risk Factors; Surgery; surgical aortic valve replacement; Surgical outcomes; Thoracic surgery; Thorax; thromboembolism; thrombolytic therapy; Thrombosis; Thrombosis - diagnosis; Thrombosis - etiology; Thrombosis - therapy; transcatheter aortic valve replacement; Warfarin; United States > US; heart valve prosthesis; HALT; thromboembolism; THV; TTE; AF; 4-dimensional computed tomography; NOAC; BPV; PPM; SAVR; TAVR; 4D; OAC; CT; ACT; BPVT; TEE; thrombolytic therapy; transcatheter aortic valve replacement; surgical aortic valve replacement; DAPT; bioprosthetic valve; bioprosthetic valve thrombosis; hypoattenuated leaflet thickening; atrial fibrillation; 4-dimensional; novel oral anticoagulant agent; prosthesis-patient mismatch; computed tomography; activated clotting time; dual-antiplatelet therapy; transcatheter heart valve; transthoracic echocardiography; transesophageal echocardiography; oral anticoagulation
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2017.02.051

Bioprosthetic valve (BPV) thrombosis is considered a relatively rare clinical entity. Yet a more recent analysis involving a more systematic echocardiographic follow-up, the advent of transcatheter heart valve (THV) technologies coupled with the highly sensitive nature of 4-dimensional computed tomographic imaging for detecting subclinical thrombi upon both surgically implanted and THVs, has generated enormous interest in this field, casting new light on both its true incidence and clinical relevance. Debate continues among clinicians as to both the clinical relevance of subclinical BPV thrombosis and the value of empirical oral anticoagulation following BPV implantation. Furthermore, currently no systematic, prospective data exist regarding the optimal treatment approach in THV recipients. The authors provide an overview of the clinical and subclinical spectrum of BPV thrombosis of surgical and THVs, outline its diagnostic challenges, summarize its pathophysiological basis, and discuss various therapeutic options that are emerging, particularly within the rapidly expanding field of THV implantation. [Display omitted]