최연우 (울산대학교 의과대학, 서울아산병원)

한빛사논문

조회482

최연우Yeonwoo Choi

울산대학교 의과대학, 서울아산병원

JACC-Cardiovasc. Interv., Dec 25 2023, 16 (24) S1936-8798(23)01385-7 | https://doi.org/10.1016/j.jcin.2023.10.024 Frequency, Predictors, and Clinical Impact of Valvular and Perivalvular Thrombus After Transcatheter Aortic Valve Replacement

Yeonwoo Choi MD ^a, Jung-Min Ahn MD ^a, Do-Yoon Kang MD ^a, Hwa Jung Kim PhD ^b, Hoyun Kim MD ^a, Jinho Lee MD ^a, Mijin Kim MD ^a, Jinsun Park MD ^a, Kyung Won Kim MD ^c, Hyun Jung Koo MD ^d, Dong Hyun Yang MD ^d, Seung Chai Jung MD ^d, Byungjun Kim MD ^e, Yiu Tung Anthony Wong MD ^f, Cheung Chi Simon Lam MD ^f, Wei-Hsian Yin MD ^g, Jeng Wei MD ^g, Yung-Tsai Lee MD ^g, Hsien-Li Kao MD^h, Mao-Shin Lin MD ^h, Tsung-Yu Ko MD ⁱ, Won-Jang Kim MD ^j, Se Hun Kang MD ^j, Seung-Ah Lee MD ^a, Dae-Hee Kim MD ^a, Jae-Hong Lee MD ^k, Seung-Jung Park MD ^a, Duk-Woo Park MD ^a on behalf of theADAPT-TAVR Investigators

^aDivision of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

^bDivision of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

^cAsan Image Metrics, Clinical Trial Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea

^dDepartment of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

^eDepartment of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Korea

^fDivision of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong

^gHeart Center, Cheng Hsin General Hospital, Taipei, Taiwan

^hDivision of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

ⁱDivision of Cardiology, Department of Internal Medicine, Hsin-Chu Branch, National Taiwan University Hospital, Hsin-Chu, Taiwan

^jDepartment of Cardiology, CHA Medical Center, Korea

^kDepartment of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Address for correspondence: Dr Duk-Woo Park

Abstract

Background: Subclinical aortic valve complex (valvular and perivalvular) thrombus is not rare after transcatheter aortic valve replacement (TAVR). The risk factors and clinical implications of these findings remain uncertain.

Objectives: This study sought to evaluate the frequency, predictors, and clinical outcome of aortic valve complex thrombus after TAVR.

Methods: In the ADAPT-TAVR (Anticoagulation Versus Dual Antiplatelet Therapy for Prevention of Leaflet Thrombosis and Cerebral Embolization After Transcatheter Aortic Valve Replacement) trial comparing edoxaban vs dual antiplatelet therapy in TAVR patients without an indication for chronic anticoagulation, the frequency of valvular (subclinical leaflet thrombus) and perivalvular (supravalvular, subvalvular, and sinus of Valsalva) thrombus was evaluated by 4-dimensional computed tomography at 6 months. The association of these phenomena with new cerebral thromboembolism on brain magnetic resonance imaging, neurologic and neurocognitive dysfunction, and clinical outcomes was assessed.

Results: Among 211 patients with 6-month computed tomography evaluations, 91 patients (43.1%) had thrombus at any aortic valve complex, 30 (14.2%) patients had leaflet thrombus, and 78 (37.0%) patients had perivalvular thrombus. A small maximum diameter of the stent at the valve level and low body surface area were independent predictors of aortic valve complex and perivalvular thrombus, and decreased renal function was an independent predictor of leaflet thrombus. No significant differences were observed in new cerebral lesions, neurologic or neurocognitive functions, or clinical outcomes among patients with or without valvular or perivalvular thrombus.

Conclusions: Subclinical aortic valve complex (valvular and perivalvular) thrombus was common in patients who had undergone successful TAVR. However, these imaging phenomena were not associated with new cerebral thromboembolism, neurologic or neurocognitive dysfunction, or adverse clinical outcomes. (Anticoagulation Versus Dual Antiplatelet Therapy for Prevention of Leaflet Thrombosis and Cerebral Embolization After Transcatheter Aortic Valve Replacement [ADAPT-TAVR]; NCT03284827).

논문정보

형식Research article
게재일2023년 12월 (BRIC 등록일 2023-12-29)
연구진국내(교신)+국외 연구진
분야 의약학 > 의약학 기타

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