Subclinical Leaflet Thrombosis Following Surgical and Transcatheter Aortic Valve Replacement: A Meta-Analysis

Subclinical leaflets valve thrombosis (SLT) is a recently identified phenomenon with multi-detector computer tomography after tissue aortic valve replacement. Whether SLT is more frequent after transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) is currently not known. Thus, the aim of this pairwise meta -analysis was to investigate the incidence of SLT after both TAVR and SAVR, the associa-tion with anticoagulation therapy, and the risk for neurological events. We searched PubMed, Google Scholar, and Ovid MEDLINE/Embase (January 02, 2023, last update) (PROSPERO registration: CRD42022383295). Statistical analysis was performed accord-ing to a prespecified statistical analysis plan. Time-to-event outcomes were summarized as incidence rate ratios (IRR). Pooled estimates were calculated using inverse variance method and random effect model. Overall, 2 registries, 2 randomized trials, and 1 obser-vational study (1,593 patients) were included in this meta-analysis. There was a statisti-cally significant difference in the incidence rate at follow-up of SLT between patients who underwent TAVR and SAVR (IRR 2.07, 95% confidence interval [CI]: [1.06; 4.03], I2 79%, 95% CI: [44; 92], p = 0.03). Oral anticoagulation therapy was associated with a reduced incidence of SLT (IRR 7.51, 95% CI: [3.24; 17.37], I2 62%, 95% CI: [0; 87], p <0.001). However, the incidence of later neurological events did not differ between patients with or without SLT (IRR 1.05, 95% CI: [0.32; 3.47], p = 0.93). In conclusion, SLT was more frequently detected after TAVR than SAVR. However, it was not associ-ated with an increased risk for neurological events. Oral anticoagulation therapy seemed to reduce the incidence of SLT. & COPY; 2023 Elsevier Inc. All rights reserved. (Am J Cardiol 2023;204:171-177)

Automated summary

This meta-analysis examined the incidence of subclinical leaflets valve thrombosis (SLT) after transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR), the association with anticoagulation therapy, and the risk for neurological events. The study found that SLT was more common after TAVR compared to SAVR, and oral anticoagulation therapy reduced the incidence of SLT. However, SLT was not associated with an increased risk for neurological events.