Hypoattenuated Leaflet Thickening After Implantation of the ACURATE neo or the ACURATE neo2 Transcatheter Heart Valve.

Subclinical leaflet thrombosis, identified as hypoattenuated leaflet thickening (HALT) on cardiac computed tomography scan, has been observed after transcatheter aortic valve replacement (TAVR). However, data on HALT after the implant of the supra-annular ACURATE neo/neo2 prosthesis are limited. This study aimed to determine the prevalence and risk factors for the development of HALT after TAVR with the ACURATE neo/neo2. A total of 50 patients who received the ACURATE neo/neo2 prosthesis were prospectively enrolled. Patients underwent a contrast-enhanced multidetector row cardiac computed tomography scan at before, after, and 6 months after TAVR. At the 6-month follow-up, HALT was detected in 16% (8 of 50 patients). These patients had a lower implant depth of the transcatheter heart valve (8 ± 2 mm vs 5 ± 2 mm, p = 0.001), less calcified native valve leaflets, a better expansion of the frame at the level of the left ventricular outflow tract, and were less often hypertensive. Thrombosis of the sinus of Valsalva occurred in 18% (9/50). There was no difference in the anticoagulation regimen between patients with and without thrombotic findings. In conclusion, HALT was present in 16% of patients at 6 months follow-up, patients presenting with HALT had a lower implant depth of the transcatheter heart valve, and HALT was detected in patients on oral anticoagulation therapy.

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Declaration of Competing Interest Dr. Toggweiler is a consultant and proctor for Boston Scientific, Medtronic, Edwards Lifesciences, Abbott, and Biosensors; a consultant for Medira, Atheart Medical, Veosource, Shockwave, Teleflex, Polares Medical, Cardiac Dimensions, ReCor Medical; has received institutional research grants from Boston Scientific, Novartis, and Fumedica AG; and holds equity in Hi-D Imaging. Dr. Stämpfli has received consulting, proctoring, or speaker fees from Abbott, Alnylam, Amgen, AstraZeneca, Bayer-Myers Squibb, Fumedica, Novartis, Polares Medical, Pfizer, and Takeda. Dr. Bossard received speaker and consulting fees from Abbott Vascular, Abiomed, and SIS Medical. Dr. Wolfrum is a proctor for Biosensors. The remaining authors have no conflicts of interest to declare.