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Thrombotic Risk and Antithrombotic Strategies After Transcatheter Mitral Valve Replacement Coronary Calcification and Long-Term Outcomes According to Drug-Eluting Stent Generation Healed coronary plaque rupture as a cause of rapid lesion progression: a case demonstrated with in vivo histopathology by directional coronary atherectomy The Hybrid Approach to Chronic Total Occlusion Percutaneous Coronary Intervention: Update From the PROGRESS CTO Registry Sustainable Antirestenosis Effect With a Low-Dose Drug-Coated Balloon: The ILLUMENATE European Randomized Clinical Trial 2-Year Results Percutaneous Treatment and Outcomes of Small Coronary Vessels: A SCAAR Report Outcomes After Orbital Atherectomy of Severely Calcified Left Main Lesions: Analysis of the ORBIT II Study Orbital atherectomy for the treatment of small (2.5mm) severely calcified coronary lesions: ORBIT II sub-analysis Association Between Malignant Mitral Valve Prolapse and Sudden Cardiac Death: A Review Orbital atherectomy for the treatment of small (2.5mm) severely calcified coronary lesions: ORBIT II sub-analysis

Review ArticleJACC: Cardiovascular Interventions

JOURNAL:JACC Cardiovasc Interv. Article Link

Thrombotic Risk and Antithrombotic Strategies After Transcatheter Mitral Valve Replacement

M Pagnesi, F Moroni, A Beneduce et al. Keywords: antithrombotic therapy; anticoagulation; thrombosis; THV; TMVR

ABSTRACT

Severe mitral regurgitation (MR) is fairly common in the general population and is associated with significant morbidity and mortality. Although surgical mitral valve (MV) repair and replacement are well established treatment options for MV disease, as much as one-half of patients with severe, symptomatic MR are not referred for surgery due to prohibitive procedural risk. Novel transcatheter alternatives are therefore being developed to provide an alternative treatment for these patients. A growing experience with transcatheter MV replacement (TMVR) strategies is accumulating and promising early results have been reported. However, the risk of transcatheter heart valve (THV) thrombosis seems to be relevant after TMVR, potentially higher than that observed after transcatheter aortic valve replacement, and routine anticoagulant therapy appears to be necessary to mitigate this risk. Hereafter, the authors: 1) review available evidence on thrombotic risk after TMVR (including new dedicated THVs for native MV, valve-in-valve, valve-in-ring, and valve-in-mitral annular calcification); and 2) discuss the antithrombotic treatment strategies after TMVR.