Valvular & structural heart disease
Pathology of Self-Expanding Transcatheter Aortic Bioprostheses and Hypoattenuated Leaflet Thickening
Authors' conclusion
HALT represents the presence of a thrombus and its progression. Our data suggest that treatment of HALT would likely be most effective in the early stages before the thrombus becomes organized and emphasizes the need for early detection.
Study context
- Population
- Self-expanding transcatheter aortic valves collected through autopsy or surgical explant from CoreValve/Evolut clinical trials; cases with infective endocarditis or transcatheter aortic valve-in-surgical aortic valve procedures excludedself-expanding transcatheter aortic valves collected, 110 cases analysed after exclusions · autopsy 89 · surgical explant 34 · excluded: infective endocarditis 10/123 · excluded: transcatheter aortic valve-in-surgical aortic valve procedures 3/123
- Participants
- 123 valves
- Comparison
- microCT findings of suspected hypoattenuated leaflet thickening (HALT) compared with histology findings of valve thrombosis and its characterization over time
- <30 daysn = 42
- 30 to 365 daysn = 35
- >365 daysn = 33
- Outcome
- Thrombus and inflammation scores
Methodological detailsautopsy or surgical explant, 11 CoreValve/Evolut clinical trials, microCT imaging
- Autopsy or surgical explant
- 11 CoreValve/Evolut clinical trials
- microCT imaging
Main finding
As reported in the abstract
- Thrombus and inflammation scores were consistent across groups
Further findings
- Type of thrombus by implant duration — <30 days
- all leaflet thickening was due to acute thrombus
Pannus, calcification and structural change scores
- Scores for pannus, calcification, and structural change increased over time
Leaflet thickening by histology
- Leaflets analysed
- 320
- Any degree of leaflet thickening
- 46.5% (149/320)
- Leaflet thickening confirmed as an acute, organizing, and organized thrombus (ie, pannus)
Type of thrombus by implant duration
- Most thrombi were organized >30 days
Differentiation of thrombus types by microCT
- The types of thrombi could not be differentiated by microCT imaging
Original publication
Pathology of Self-Expanding Transcatheter Aortic Bioprostheses and Hypoattenuated Leaflet Thickening. Circ Cardiovasc Interv. Published 18 February 2025. doi:10.
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