Is SLT More Common After Surgical or Transcatheter Aortic Valve Replacement?

Subclinical leaflets valve thrombosis (SLT) was detected more frequently in patients who underwent transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (SAVR), according to research published in The American Journal of Cardiology.

Additionally, oral anticoagulation therapy appeared to reduce the incidence of SLT; however, the authors, led by Marco Moscarelli, MD, PhD, did not identify an association between SLT and increased risk for neurological events.

SLT was recently identified as an easy-to-miss complication following TAVR or SAVR. Initial studies suggested that SLT was more common after TAVR versus SAVR, and was associated with neurological events such as stroke.

The researchers conducted a pairwise meta-analysis to characterize SLT after TAVR and SAVR and its association with neurological events, as well as the impact of anticoagulation therapy.

SLT Risk Appears Higher After TAVR Versus SAVR

The meta-analysis included a total of 1,593 patients collated from two registries, two randomized trials, and one observational study that were published in the PubMed, Google Scholar, and Ovid Medline/Embase databases by January 2, 2023. Analysts characterized outcomes as incidence rate ratios (IRR) for patients with SLT after TAVR and SAVR.

Reportedly, the SLT incidence during follow-up was greater after TAVR versus SAVR with a statistically significant IRR of 2.07 (95% CI, 1.06-4.03; I²=79%; 95% CI, 44-92; P=.03). Oral anticoagulation therapy appeared to significantly reduce the incidence of SLT with an IRR of 7.51 (95% CI, 3.24-17.37; I²=62%; 95% CI, 0-87; P<.001). Neurological events were not significantly different between TAVR and SAVR with an IRR of 1.05 (95% CI, 0.32-3.47; P=.93).

Based on their analysis, the authors suggested that SLT was more common after TAVR versus SAVR, though SLT did not appear to be associated with increased risk of adverse neurological events, and oral anticoagulants seemed to significantly reduce the risk of SLT.

Reference

Moscarelli M, Prestera R, Pernice V, et al. Subclinical leaflet thrombosis following surgical and transcatheter aortic valve replacement: a meta-analysis. Am J Cardiol. 2023;204:171-177. doi:10.1016/j.amjcard.2023.07.089

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