경피적 판막 치환술 시행한 환자에서 무증상 판막엽 혈전증이 판막의 혈역학 및 판막 기능 이상에 미치는 영향

Abstract

Background: The effect of subclinical leaflet thrombosis, characterized by hypoattenuated leaflet thickening (HALT), on the valve hemodynamic function and durability of the bioprosthetic valve has not been yet determined.

OBJECTIVES: This study aimed to determine the impact of HALT on valve hemodynamics detected by serial echocardiography after transcatheter aortic valve replacement (TAVR).

METHODS: The ADAPT-TAVR trial is a multicenter, randomized trial that compared edoxaban and dual antiplatelet therapy in patients without an indication for anticoagulation who had undergone successful TAVR. The presence of HALT was evaluated by four-dimensional computed tomography (CT) at 6 months and serial echocardiography performed at baseline, immediately post-TAVR, and after 6 months of follow-up. The relationship of HALT with valve hemodynamics and hemodynamic structural valve deterioration (SVD) was assessed.

RESULTS: At 6 months, HALT was found in 30 of 211 (14.2%) patients with evaluable cardiac CT scans. The presence of HALT did not significantly affect mean aortic valve mean gradients (with vs. without HALT; 14.0 ± 4.8 mmHg vs. 13.7 ± 5.5 mmHg; p=0.742) and mean aortic valve area (1.64 ± 0.44 cm2 vs. 1.54 ± 0.36 cm2; p=0.208) at 6 months. No significant baseline predictors were noted for HALT at 6 months. At least moderate hemodynamic SVD was reported in 30 of 206 patients (14.6%) at the time of the echocardiography at 6-month follow-up echo. The use of aortic valve size ≤ 23 mm and smaller aortic valve area were independent predictors of the development of hemodynamic structural valvular dysfunction; however, the presence of HALT was not identified as a predictor of hemodynamic SVD.

CONCLUSIONS: In patients who had undergone successful TAVR, aortic valve hemodynamic status was not influenced by the presence of HALT. Although HALT was not a predictor of hemodynamic SVD at 6 months, it warrants further longer-term follow-up studies are warranted to evaluate the impact of valve durability and also this study was not powered for clinical outcomes.