Author + information
- Berhane M. Workua,b,
- Polydoros Kampaktsisa,b,
- Iosif Gulkarova,b,
- Shing-Chiu Wonga,b,
- Regis Changa,b,
- Abdullah Aftaba,b and
- Arash Salemia,b
Background: Left atrial thrombus (LAT) and spontaneous echo contrast (SEC) are risk markers for cardioembolization. LAT was an exclusion criterion in the transcatheter aortic valve replacement (TAVR) trials although such patients undergo TAVR in the “real-world” setting. In this study we analyze outcomes after TAVR in patients with LAT or SEC.
Methods: All patients undergoing TAVR at our institution between March 2009 and December 2014 were analyzed. Preoperative, intraoperative, and postoperative variables were collected prospectively. The presence of LAT or SEC was determined via retrospective chart review. Primary outcomes include 30-day and one-year neurologic events and mortality.
Results: Between March 2009 and December 2014, 369 patients underwent TAVR at our institution. Of these, 3.8% (14) were found to have LAT and 6.8% (25) were found to have SEC. Significant differences were noted between patients with LAT, SEC, or neither with regards to preoperative renal function, atrial fibrillation (AF), and ejection fraction. Preoperative AF was the only independent predictor of LAT (OR 8.7; CI 1.9-40.1; p=.006). No perioperative complications were associated with the presence of LAT or SEC. Specifically, no patient with LAT or SEC experienced a postoperative neurologic event. Kaplan-meier analysis revealed increased overall mortality in patients with LAT (log-rank p=0044). However, independent predictors of 30-day and one-year survival included preoperative AF (30-day OR .04; CI .003-.45; p=.01; 1-year OR .02; CI .001-.29; p=.004), as well as postoperative neurologic events, life threatening bleeding complications, and moderate-severe aortic regurgitation, but not LAT.
Conclusions: The current study suggests that TAVR may be performed in patients with LAT and SEC with a low risk of embolic complications. LAT is associated with increased long-term mortality, although this is likely a function of its association with AF. Larger, randomized studies are needed to better study this phenomenon.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Interventional Cardiology: TAVR 3
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 1243-187
- 2017 American College of Cardiology Foundation