Advertisement
Heart, Lung and Circulation

Leaflet Immobility and Hypo-Attenuated Leaflet Thrombosis (HALT)–Under-Recognised Complications of Bioprosthetic Valve Replacements

      Bioprosthetic leaflet immobility is under-recognised and is highlighted by an article by Naser et al. [
      • Naser J.A.
      • Crestanello J.A.
      • Nkomo V.T.
      • Luis S.A.
      • Thaden J.T.
      • Geske J.B.
      • et al.
      Immobile leaflets at time of bioprosthetic valve implantation: A novel risk factor for early bioprosthetic failure.
      ] in this edition of Heart, Lung and Circulation. The authors assert in their conclusions that “Immobile leaflet immediately post-bioprosthetic valve implantation is frequently under-recognised intra-operatively and appears to be associated with early bioprosthetic dysfunction and worse clinical outcome”. The valves assessed were predominantly porcine and while the number of cases is small, there was not much detail on the overall percent incidence of this issue. However, the presence of early bioprosthetic valve regurgitation and leaflet hypomobility is something that most cardiac surgeons and cardiac anesthetists are aware of, even if reported findings are uncommon.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart, Lung and Circulation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Naser J.A.
        • Crestanello J.A.
        • Nkomo V.T.
        • Luis S.A.
        • Thaden J.T.
        • Geske J.B.
        • et al.
        Immobile leaflets at time of bioprosthetic valve implantation: A novel risk factor for early bioprosthetic failure.
        Heart Lung Circ. 2022; 31: 1165-1175
        • Surman T.L.
        • Abrahams J.M.
        • Williams-Spence J.
        • Edwards J.
        • Worthington M.G.
        • Beltrame J.
        • Smith J.A.
        Clinical outcomes in surgical and transcatheter aortic valve replacement: An ANZSCTS Database review 2001-2019.
        Heart Lung Circ. 2022; 31: 1153-1165
        • Garcia S.
        • Fukui M.
        • Dworak M.W.
        • Okeson B.K.
        • Garberich R.
        • Hashimoto G.
        • et al.
        Clinical impact of hypoattenuating leaflet thickening after transcatheter aortic valve replacement.
        Circ Cardiovasc Interv. 2022; 15e011480
        • Nicolas J.
        • Dangas G
        Hypoattenuated leaflet thickening after transcatheter aortic valve replacement: Additional data, yet still many unanswered questions.
        Circ Cardiovasc Interv. 2022; 15e011828
        • Makkar R.R.
        • Fontana G.
        • Jilaihawi H.
        • Chakravarty T.
        • Kofoed K.F.
        • De Backer O.
        • et al.
        Possible subclinical leaflet thrombosis in bioprosthetic aortic valves.
        N Engl J Med. 2015; 373: 2015-2024
        • Martín M.
        • Cuevas J.
        • Cigarrán H.
        • Calvo J.
        • Morís C.
        Transcatheter aortic valve implantation and subclinical and clinical leaflet thrombosis: Multimodality imaging for diagnosis and risk stratification.
        Eur Cardiol. 2021; 16: e35
        • Pache G.
        • Schoechlin S.
        • Blanke P.
        • Dorfs S.
        • Jander N.
        • Arepalli C.D.
        • et al.
        Early hypo-attenuated leaflet thickening in balloon-expandable transcatheter aortic heart valves.
        Eur Heart J. 2016; 37: 2263-2271
        • Puri R.
        • Auffret V Rodés-Cabau J.
        Bioprosthetic valve thrombosis.
        J Am Coll Cardiol. 2017; 69: 2193-2211
        • Puvimanasinghe J.P.
        • Steyerberg E.W.
        • Takkenberg J.J.
        • Eijkemans M.J.
        • van Herwerden L.A.
        • Bogers A.J.
        • et al.
        Prognosis after aortic valve replacement with a bioprosthesis: predictions based on meta-analysis and microsimulation.
        Circulation. 2001; 103: 1535-1541
        • Sondergaard L.
        • De Backer O.
        • Kofoed K.F.
        • Jilaihawai H.
        • Fuchs A.
        • Chakravarty T.
        • et al.
        Natural history of subclinical leaflet thrombosis affecting motion in bioprosthetic aortic valves.
        Eur Heart J. 2017; 38: 2201-2207
        • Oliveira D.C.
        • Okutucu S.
        • Russo G.
        • Campos Martins E.C.
        The issue of subclinical leaflet thrombosis after transcatheter aortic valve implantation.
        Cardiol Res. 2020; 11: 269-273
        • Campion G.
        • Hershberger K.
        • Whelan A.
        • Conroy J.
        • Lally C.
        • Murphy B.P.
        A biomechanical and microstructural analysis of bovine and porcine pericardium for use in bioprosthetic heart valves.
        Structural Heart. 2021; 5: 486-496
        • Dalgliesh A.J.
        • Parvizi M.
        • Noble C.
        • Griffiths L.G.
        Effect of cyclic deformation on xenogeneic heart valve biomaterials.
        PLoS One. 2019; 14e0214656
        • Vesely I.
        Heart valve tissue engineering.
        Circ Res. 2005; 97: 743-755
        • Tam H.
        • Zhang W.
        • Infante D.
        • Parchment N.
        • Sacks M.
        • Vyavahare N.
        Fixation of bovine pericardium-based tissue biomaterial with irreversible chemistry improves biochemical and biomechanical properties.
        J Cardiovasc Transl Res. 2017; 10: 194-205

      Linked Article