Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Freiburgstrasse 8, 3010 Bern, Switzerland.
Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland.
Eur Heart J Cardiovasc Imaging. 2018 Apr 1;19(4):398-404. doi: 10.1093/ehjci/jex181.
To assess the incidence, management and long-term outcomes of transcatheter heart valve thrombosis (THVT).
Between August 2007 and February 2016, 1396 patients were included in the Bern TAVI Registry and prospectively followed-up through echocardiographic and clinical evaluation. THVT was suspected in case of: (i) a mean transvalvular pressure gradient greater than 20 mmHg at transthoracic echocardiography, or (ii) an increase of more than 50% of the mean transvalvular pressure gradient compared with previous measurements or (iii) new symptoms or signs of heart failure with the presence of thrombus documented by transoesophageal echocardiography or multi-slice computed tomography. THVT occurred in 10 patients (0.71%) at variable time points after TAVI. Increased transvalvular pressure gradients were recorded in all patients and 7 out of 10 patients were symptomatic. Oral anticoagulant therapy (with vitamin K antagonists or non-Vitamin K antagonists) was initiated in all but two patients and resulted in normalization of transvalvular pressure gradients and amelioration of clinical status within 1 month. At long-term follow-up (between 10 and 25 months after valve thrombosis), echocardiographic findings were stable and no adverse events were reported.
THVT is rarely detected at routine clinical and echocardiographic evaluation after TAVI. Oral anticoagulation appears effective to normalize transvalvular gradients in the majority of cases with stable clinical and haemodynamic evolution during long-term follow-up.
评估经导管心脏瓣膜血栓形成（THVT）的发生率、处理方法和长期结局。
在 2007 年 8 月至 2016 年 2 月期间，1396 例患者被纳入 Bern TAVI 注册研究，并通过超声心动图和临床评估进行前瞻性随访。怀疑发生 THVT 时，符合以下三种情况之一：（i）经胸超声心动图显示平均跨瓣压差大于 20mmHg；（ii）与之前的测量值相比，平均跨瓣压差增加超过 50%；（iii）新出现心力衰竭症状或体征，且经食管超声心动图或多层螺旋 CT 检查发现血栓。TAVI 后不同时间点有 10 例（0.71%）患者发生 THVT。所有患者的跨瓣压差均升高，其中 7 例患者有症状。所有患者均开始接受口服抗凝治疗（维生素 K 拮抗剂或非维生素 K 拮抗剂），除 2 例患者外，其余患者的跨瓣压差在 1 个月内恢复正常，临床状况改善。在长期随访（血栓形成后 10 至 25 个月）期间，超声心动图检查结果稳定，未报告不良事件。
TAVI 后常规临床和超声心动图评估很少发现 THVT。口服抗凝治疗在大多数病例中似乎有效，可使跨瓣压差恢复正常，且在长期随访期间临床和血液动力学状况稳定。
