Early thrombus formation including hypo-attenuated leaflet thrombosis after surgical bioprosthetic aortic valve replacement

Takanori Kono; Kazuyoshi Takagi; Tohru Takaseya; Tomofumi Fukuda; Kosuke Saku; Yasuyuki Zaima; Takahiro Shojima; Koichi Arinaga; Eiki Tayama

doi:10.1007/s11748-024-02010-4

Early thrombus formation including hypo-attenuated leaflet thrombosis after surgical bioprosthetic aortic valve replacement

Gen Thorac Cardiovasc Surg. 2024 Feb 26. doi: 10.1007/s11748-024-02010-4. Online ahead of print.

Authors

Takanori Kono¹, Kazuyoshi Takagi², Tohru Takaseya², Tomofumi Fukuda², Kosuke Saku², Yasuyuki Zaima², Takahiro Shojima², Koichi Arinaga², Eiki Tayama²

Affiliations

¹ Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan. kono_takanori@med.kurume-u.ac.jp.
² Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.

PMID: 38403822
DOI: 10.1007/s11748-024-02010-4

Abstract

Objective: To assess the occurrence, predictors, and outcomes of hypo-attenuated leaflet thickening (HALT) and thrombus outside the prosthetic valve following surgical aortic valve replacement.

Methods: A total of 118 patients underwent surgical aortic valve replacement with bioprosthetic valves between July 2020 and June 2022. Sixty-two (52.5%) patients, which is a fairly high number of patients, underwent cardiac computed tomography and transthoracic echocardiography one week after surgery. Patients were divided into two groups, those with HALT (n = 14) and those without HALT (n = 48).

Results: Of the 62 patients who underwent cardiac computed tomography, HALT was observed in 14 (22.5%) patients during the very early postoperative phase. Reduced leaflet motion was observed in two of the 14 patients. The low-attenuation areas were located outside the prosthetic valve in 10 cases (71.4%) in the HALT group and in 14 cases (29.2%) in the non-HALT group. More than 50% of patients (57.1%) with HALT and 79.2% without HALT were administered warfarin. Neither in-hospital deaths nor postoperative thromboembolic events were observed during hospitalization. No patient had a mean pressure gradient > 20 mmHg in either group.

Conclusion: HALT was observed in one-fifth of the cases after surgical aortic valve replacement during the very early postoperative phase in an institution wherein administration of continuous heparin infusion after surgery is a standard practice. HALT did not affect the early prognosis or incidence of cerebral infarction.

Keywords: Aortic valve replacement; Bioprosthetic valve; Hypo-attenuated leaflet thrombosis.