Author + information
- Hashrul Rashid1,
- Abdul Rahman Ihdayhid2,
- Liam McCormick3,
- Nitesh Nerlekar4,
- James Cameron5,
- Arthur Nasis6,
- Robert Gooley3 and
- Adam Brown2
- 1Monash Health, Melbourne, Victoria, Australia
- 2MonashHeart, Monash Medical Centre, Clayton, Victoria, Australia
- 3MonashHeart, Monash Health, Melbourne, Victoria, Australia
- 4MonashHeart, Clayton, Victoria, Australia
- 5Monash University, Melbourne, Victoria, Australia
- 6MonashHeart, Melbourne, Victoria, Australia
Leaflet thrombosis (LT) is becoming increasingly recognized following transcatheter and surgical aortic bioprosthetic valve (ABV) replacement and can be identified by multidetector computed tomography (MDCT). However, there is ongoing debate whether MDCT-defined LT is associated with adverse cerebrovascular outcomes.
Electronic databases were searched for studies that performed mandatory MDCT imaging of patients following ABV. The primary endpoint was the incidence of cerebrovascular events, defined as the composite of stroke or transient ischaemic attack (TIA). Secondary endpoints included major adverse cerebrovascular and cardiovascular events (MACCE), stroke, TIA, death and myocardial infarction.
In total, 6 studies met inclusion criteria with 11.6% (198/1704) of patients having MDCT-defined LT. The prevalence of LT following transcatheter and surgical ABV was 13.2% and 3.6%, respectively. Cerebrovascular events were significantly increased in patients with LT (Odds Ratio [OR] 3.38, 95%CI 1.78-6.41, I2=0%, p<0.001)(Figure). The risk of MACCE (OR 2.10, 95%CI 1.21-3.64, p<0.001) and TIA (OR 5.86, 95%CI 2.05-16.75, p<0.001) were also increased in patients with LT, although there were no differences in the incidence of stroke (OR 2.43, 95%CI 1.00-5.93, p=0.05), death (OR 0.92, 95%CI 0.42-2.03, p=0.84) or myocardial infarction (OR 1.72, 95%CI 0.34-9.78, p=0.54) between groups.
MDCT-defined LT following ABV replacement is associated with a significantly increased risk of adverse cerebrovascular events. Further prospective studies are required to ascertain whether LT can be treated or prevented with pharmacological strategies.
STRUCTURAL: Valvular Disease: Aortic