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. 2025 Apr;105(5):1161-1170.
doi: 10.1002/ccd.31435. Epub 2025 Feb 3.

Long-Term Impact of Early Subclinical Leaflet Thrombosis After Transcatheter Aortic Valve Implantation

Juri Iwata  1 , Kentaro Hayashida  1 , Ryo Arita  1 , Tomonari Moriizumi  1 , Akiyoshi Kajino  1 , Shingo Sakata  1 , Toshinobu Ryuzaki  1 , Keitaro Shinada  1 , Hikaru Tsuruta  1 , Yoshitake Yamada  2 , Jungo Kato  3 , Tatsuo Takahashi  4 , Masataka Yamazaki  4 , Masahiro Jinzaki  2 , Hideyuki Shimizu  4 , Masaki Ieda  1
Affiliations

Long-Term Impact of Early Subclinical Leaflet Thrombosis After Transcatheter Aortic Valve Implantation

Juri Iwata et al. Catheter Cardiovasc Interv. 2025 Apr.

Abstract

Background: Hypoattenuated leaflet thickening (HALT) after transcatheter aortic valve implantation (TAVI) detected on multidetector computed tomography (MDCT) is considered leaflet thrombosis. However, its impact on long-term clinical outcomes remains unclear. This study aimed to investigate the impact of early HALT detection after TAVI on long-term clinical outcomes and structural valve deterioration beyond 6 years.

Methods: Of the 672 consecutive patients who underwent TAVI between 2013 and 2018, 448 were treated with either SAPIEN XT or SAPIEN 3 and underwent MDCT analysis within 30 days after TAVI. MDCT results and echocardiographic data were analyzed annually.

Results: HALT was detected in 68 (15.2%) of 448 eligible patients within 30 days after TAVI. No significant difference in effective orifice area was observed by echocardiography within 30 days after TAVI between the HALT and the non-HALT groups in SAPIEN XT (HALT vs. non-HALT: 1.62 ± 0.66 cm2 vs. 1.72 ± 0.43 cm2; p = 0.26) and in SAPIEN 3 (1.42 ± 0.35 cm2 vs. 1.45 ± 0.34 cm2; p = 0.63). No significant differences in all-cause mortality (52.9% vs. 60.0%; hazard ratio (HR): 1.19; 95% confidence interval (CI): 0.83-1.70; p = 0.3), stroke incidence (5.9% vs. 7.1%; HR: 1.06; 95% CI: 0.08-13.7; p = 0.97), heart failure rehospitalization (10.3% vs. 15.0%; HR: 2.3; 95% CI: 0.89-5.99; p = 0.09), and structural valve deterioration (14.7% vs. 17.9%; HR: 0.89; 95% CI: 0.45-1.73; p = 0.73) were observed between the HALT and the non-HALT groups during the median follow-up of 1872 (interquartile range; 1203-2468) days.

Conclusions: HALT within 30 days was not associated with clinical outcomes or hemodynamic performance during long-term follow-up.

Keywords: balloon‐expandable valve; hypoattenuated leaflet thickening; long‐term; structural valve deterioration; transcatheter aortic valve implantation.

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Conflict of interest statement

Dr. Hayashida is a clinical proctor for Edwards Lifesciences, Abbott Medical, and Medtronic. Dr. Shimizu and Dr. Takahashi are clinical proctors at Edwards Life Sciences. Dr. Tsuruta is a clinical screening proctor for Edwards Lifesciences. The other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study cohort. CKD, chronic kidney disease; HALT, hypoattenuated leaflet thickening; MDCT, multidetecter computed tomography; TAVI, transcatheter aortic valve implantation. [Color figure can be viewed at wileyonlinelibrary.com]
Figure 2
Figure 2
Kaplan−Meier survival analysis. (A) All‐cause mortality. (B) Cardiovascular death. (C) Structural valve deterioration. HALT, hypoattenuated leaflet thickening. [Color figure can be viewed at wileyonlinelibrary.com]
Figure 3
Figure 3
Over time hemodynamic assessments using echocardiography were performed according to the presence or absence of HALT. (A) Over time changes of effective orifice area. (B) Over time changes of mean pressure gradient. HALT, hypoattenuated leaflet thickening. [Color figure can be viewed at wileyonlinelibrary.com]
Central Illustration 1
Central Illustration 1
Comparison of long‐term clinical outcomes and valve deterioration with and without early detected HALT. HALT, hypoattenuated leaflet thickening; MDCT, multidetecter computed tomography; SVD, structural valve deterioration. [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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