Coagulation derangement and risk factors for valve thrombosis following transcatheter aortic valve implantation
Ronak Rajani,
Kiran Parmar,
Bernard D Prendergast,
Christopher Allen,
Simon R Redwood,
Beverley Hunt,
Julia Grapsa,
Jack Lee,
Christopher Young,
Harriet Hurrell,
Rebecca Preston,
Gianluca Lucchese,
Giulia Esposito,
Utkarsh Dutta,
Nicholas Aroney,
Fiyyaz Ahmed-Jushuf
Affiliations
Ronak Rajani
1 Cardiothoracic Centre, Guy’s and St Thomas’ Hospital, London, UK
Kiran Parmar
Department of Haematology and Thrombosis, Guy`s and St Thomas` NHS Foundation Trust, London, UK
Bernard D Prendergast
Cardiology department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
Christopher Allen
6 The Applied Health Research Centre of the Li Ka Shing Knowledge Institute, St Michael`s Hospital, Toronto, Ontario, Canada
Simon R Redwood
Rayne Institute, BHF Centre of Research Excellence, King`s College London, St Thomas` Hospital, Guy`s and St Thomas` Hospitals NHS Trust, London, UK
Beverley Hunt
4Guy’s and St Thomas’ NHS Foundation Trust, London
Julia Grapsa
Cardiovascular Department, Guy`s and St Thomas` NHS Foundation Trust, London, UK
Jack Lee
Center for Clinical Research and Biostatistics, Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
Christopher Young
Cardiovascular Department, Guy`s and St Thomas` NHS Foundation Trust, London, UK
Harriet Hurrell
Cardiovascular Division, School of Life Science and Medicine, King`s College London, London, UK
Rebecca Preston
Department of Radiology and Cardiac CT, Guy`s and St Thomas` NHS Foundation Trust, London, UK
Gianluca Lucchese
Cardiovascular Department, Guy`s and St Thomas` NHS Foundation Trust, London, UK
Giulia Esposito
King`s College London Faculty of Life Sciences and Medicine, London, UK
Utkarsh Dutta
Cardiovascular Division, School of Life Science and Medicine, King`s College London, London, UK
Nicholas Aroney
Cardiovascular Department, Guy`s and St Thomas` NHS Foundation Trust, London, UK
Fiyyaz Ahmed-Jushuf
2National Heart and Lung Institute Imperial College, London, UK
Aims Durability of transcatheter aortic valve implantation (TAVI) is key to its expansion. We sought to identify incidence of valve thrombosis and predictors of valve thrombosis in our single centre with associated coagulation testing pre-TAVI and post-TAVI.Methods and results This single-centre observational study comprised patients undergoing transfemoral TAVI discussed in the Heart Team meeting . Patients were followed up with echocardiography at 120 days to identify incidence of elevated transvalvular gradient and multivariable analysis was performed to identify factors associated with an increased odds of developing valve thrombosis. In addition, 11 patients underwent baseline, day 1 and day 120 post-TAVI coagulation testing. Between August 2017 and August 2019, 437 consecutive patients underwent transfemoral TAVI. Of these patients, 207/437 (47.4%) had 3-month follow-up echo data available and were analysed. Of these patients, 26/207 (12.6%) had elevated transvalvular gradients. These patients tended to be younger (80±14 vs 83±6 years; p=0.047) with a lower ejection fraction (49±13 vs 54%±11%; p=0.021), with a greater proportion of the population experiencing atrial fibrillation (14/21, 54% vs 68/181, 38%; p=0.067). Following multivariable analysis, there remained a trend towards higher eccentricity index associated with elevated gradients. Baseline (pre-TAVI) elevation of thrombin antithrombin levels (56±63; reference range 1.0–4.1 ng/L) and PF 1+2 (791±632; reference range 69–229 ng/mL) normalised at 120 days post-TAVIConclusion This study demonstrated that in the cohort of patients undergoing transfemoral TAVI in our centre: younger age, poor ejection fraction, atrial fibrillation and increased baseline eccentricity of the aortic valve annulus were present to a greater extent in patients exhibiting elevated transvalvular gradients at 3-month follow-up. Further work is required to delineate the extent of coagulation derangement and confirm predictors of thrombosis.
