Thrombosis of Bioprosthetic Aortic Valve: Is the Entire Arsenal Deployed?

TL;DR

This review explores bioprosthetic aortic valve thrombosis, its causes, detection methods, and potential impact on patient outcomes.

Contribution

The paper provides a comprehensive overview of bioprosthetic valve thrombosis, emphasizing the need for improved diagnosis and understanding.

Findings

Bioprosthetic valve thrombosis occurs in up to 15% of procedures but is poorly understood.

Current imaging techniques have limitations in detecting subclinical thrombosis.

There is a need for better diagnostic tools and follow-up strategies to assess clinical significance.

Abstract

The proliferation of transcatheter aortic valve implantation has alerted
clinicians to a specific type of prosthetic degeneration represented by
thrombosis. The pathogenesis of this clinical or subclinical phenomenon, which
can occur in up to 15% of both surgical and percutaneous procedures, is poorly
understood, as is its potential impact on patient prognosis and long-term
bioprosthesis durability. Based on this lack of knowledge about the real meaning
and importance of bioprosthetic valve thrombosis, the aim of the present review
is to draw the clinicians’ attention to its existence, starting from the
description of predisposing factors that may require a closer follow-up in such
categories of patients, to an in-depth overview of all available imaging
modalities with their respective pros and cons. Finally, a glimpse into the
future of technology and biomarker development is presented. The hope is to
increase the rate of bioprosthetic diagnosis, especially of the subclinical one,
in order to understand (thanks to a strict and prolonged follow-up) if it can
only be considered as an incidental tomographic entity without significant
clinical consequences, or, on the contrary, if it is associated with neurological
events or accelerated bioprosthetic degeneration. Nevertheless, despite the
technical advances of echocardiography and cardiac tomography in terms of
accurate bioprosthesis thrombosis detection, several diagnostic and therapeutic
issues remain unresolved, including possible prevention strategies, tailored
treatment protocols, and follow-up modalities.

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