Bioprosthetic Aortic Valve Thrombosis: Definitions, Clinical Impact, and Management: A State-of-the-Art Review

Circ Cardiovasc Interv. 2024 Jul;17(7):e014143. doi: 10.1161/CIRCINTERVENTIONS.123.014143. Epub 2024 Jun 10.

Abstract

Bioprosthetic aortic valve thrombosis is frequently detected after transcatheter and surgical aortic valve replacement due to advances in cardiac computed tomography angiography technology and standardized surveillance protocols in low-surgical-risk transcatheter aortic valve replacement trials. However, evidence is limited concerning whether subclinical leaflet thrombosis leads to clinical adverse events or premature structural valve deterioration. Furthermore, there may be net harm in the form of bleeding from aggressive antithrombotic treatment in patients with subclinical leaflet thrombosis. This review will discuss the incidence, mechanisms, diagnosis, and optimal management of bioprosthetic aortic valve thrombosis after transcatheter aortic valve replacement and bioprosthetic surgical aortic valve replacement.

Keywords: anticoagulants; aortic valve; bioprosthesis; computed tomography angiography; echocardiography; thrombosis; transcatheter aortic valve replacement.

Publication types

  • Review

MeSH terms

  • Anticoagulants / administration & dosage
  • Anticoagulants / adverse effects
  • Anticoagulants / therapeutic use
  • Aortic Valve* / diagnostic imaging
  • Aortic Valve* / physiopathology
  • Aortic Valve* / surgery
  • Bioprosthesis* / adverse effects
  • Fibrinolytic Agents* / administration & dosage
  • Fibrinolytic Agents* / adverse effects
  • Heart Valve Prosthesis Implantation* / adverse effects
  • Heart Valve Prosthesis Implantation* / instrumentation
  • Heart Valve Prosthesis* / adverse effects
  • Humans
  • Incidence
  • Predictive Value of Tests
  • Prosthesis Design*
  • Risk Assessment
  • Risk Factors
  • Thrombosis* / diagnostic imaging
  • Thrombosis* / etiology
  • Thrombosis* / therapy
  • Transcatheter Aortic Valve Replacement* / adverse effects
  • Transcatheter Aortic Valve Replacement* / instrumentation
  • Treatment Outcome

Substances

  • Fibrinolytic Agents
  • Anticoagulants