Prosthesis Geometrical Predictors of Leaflet Thrombosis Following Transcatheter Aortic Valve Replacement With Intra-Annular Prostheses

Central Illustration A: Computed tomography imaging of a Sapien 3 valve with leaflet thrombosis in both transverse (top left) and sagittal (top right) views. Further analysis with four-dimensional image rendering demonstrates restricted leaflet motion with transverse (bottom left) and sagittal (bottom right) views. Also note that this prosthesis had significant prosthesis misalignment with the sinus of Valsalva (bottom left). Central Illustration B: Summary of the prosthesis geometry predictors of leaflet thrombosis following transcatheter aortic valve replacement; lower prosthesis implant depth, significant prosthesis misalignment and under-expansion of the prosthesis at the annulus level. [Display omitted] To determine the association between prosthesis geometry with leaflet thrombosis (LT). Leaflet thrombosis following transcatheter aortic valve replacement (TAVR) is a recognised entity. The association between prosthesis geometry with LT is unclear but maybe a potential modifiable factor in its prevention. Patients who received an intra-annular TAVR prosthesis and were prospectively planned to undergo post-procedural computed tomography (CT) imaging were included. Leaflet thrombosis was defined as at least 50% restricted leaflet motion on CT. Prosthesis expansion and eccentricity was measured at prosthesis inflow, annulus and outflow levels. Prosthesis misalignment was defined as the average angle deviation between native and prosthesis leaflet commissure, greater than 30°. Prevalence of LT was 13.7% in 117 patients. None of the patients with LT were on anticoagulation therapy. Patients with LT had reduced prosthesis annular expansion (89.4±5.2% vs 97.0±4.4%, p