Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
JACC Cardiovasc Interv. 2018 Jun 25;11(12):1164-1171. doi: 10.1016/j.jcin.2018.04.006.
The aim of this study was to investigate medium-term outcomes in patients with leaflet thrombosis (LT).
The clinical significance of early LT after transcatheter aortic valve replacement, diagnosed by computed tomography angiography in approximately 10% of patients, is uncertain.
In this observational study, computed tomographic angiography was performed a median of 5 days after transcatheter aortic valve replacement and assessed for evidence of LT. Follow-up consisted of clinical visits, telephone contact, or questionnaire.
LT was diagnosed in 120 of 754 patients (15.9%). Patients with LT were less likely male (36.7% vs. 47.0%, p = 0.045), with a lower rate of atrial fibrillation (28.3% vs. 41.5%, p = 0.008). Peri- and post-procedural characteristics were comparable between groups (e.g., valve implantation technique; p = 0.116). During a median follow-up period of 406 days, there were no significant differences in the primary endpoint of all-cause mortality and the secondary combined endpoint of stroke and transient ischemic attack between patients with LT and those without LT (18-month Kaplan-Meier estimate for mortality 86.6% vs. 85.4%, p = 0.912; for stroke- or transient ischemic attack-free survival 98.5% vs. 96.8%, p = 0.331). In univariate and multivariate analyses, LT was not predictive of either endpoint, whereas male sex (p = 0.03), atrial fibrillation (p = 0.002), and more than mild paravalvular leak (p = 0.015) were associated with all-cause mortality.
In this prospective observational cohort undergoing post-transcatheter aortic valve replacement computed tomographic angiography, LT was not associated with increased mortality or rates of stroke over a follow-up period of 406 days.
本研究旨在探讨瓣叶血栓（LT）患者的中期结局。
经计算机断层扫描血管造影术（CTA）诊断，约 10%的经导管主动脉瓣置换（TAVR）术后患者早期发生 LT，其临床意义尚不确定。
在这项观察性研究中，在 TAVR 后中位数 5 天行 CTA，并评估 LT 的证据。随访包括临床就诊、电话联系或问卷调查。
754 例患者中诊断出 LT120 例（15.9%）。LT 患者中男性较少（36.7% vs. 47.0%，p=0.045），心房颤动发生率较低（28.3% vs. 41.5%，p=0.008）。两组围手术期和术后特征相似（例如，瓣膜植入技术；p=0.116）。在中位数为 406 天的随访期间，LT 患者与无 LT 患者在全因死亡率这一首要终点和卒中和短暂性脑缺血发作这一联合次要终点方面无显著差异（18 个月 Kaplan-Meier 估计死亡率为 86.6% vs. 85.4%，p=0.912；卒中和短暂性脑缺血发作无生存为 98.5% vs. 96.8%，p=0.331）。在单变量和多变量分析中，LT 与任何终点均无相关性，而男性（p=0.03）、心房颤动（p=0.002）和中重度瓣周漏（p=0.015）与全因死亡率相关。
在这项接受 TAVR 后 CTA 的前瞻性观察队列研究中，LT 与 406 天随访期间死亡率或卒中发生率增加无关。
