Aims Durability of transcatheter aortic valve implantation (TAVI) is key to its expansion. We sought to identify incidence of valve thrombosis and predictors of valve thrombosis in our single centre with associated coagulation testing pre-TAVI and post-TAVI. Methods and results This single-centre observational study comprised patients undergoing transfemoral TAVI discussed in the Heart Team meeting . Patients were followed up with echocardiography at 120 days to identify incidence of elevated transvalvular gradient and multivariable analysis was performed to identify factors associated with an increased odds of developing valve thrombosis. In addition, 11 patients underwent baseline, day 1 and day 120 post-TAVI coagulation testing. Between August 2017 and August 2019, 437 consecutive patients underwent transfemoral TAVI. Of these patients, 207/437 (47.4%) had 3-month follow-up echo data available and were analysed. Of these patients, 26/207 (12.6%) had elevated transvalvular gradients. These patients tended to be younger (80±14 vs 83±6 years; p=0.047) with a lower ejection fraction (49±13 vs 54%±11%; p=0.021), with a greater proportion of the population experiencing atrial fibrillation (14/21, 54% vs 68/181, 38%; p=0.067). Following multivariable analysis, there remained a trend towards higher eccentricity index associated with elevated gradients. Baseline (pre-TAVI) elevation of thrombin antithrombin levels (56±63; reference range 1.0–4.1 ng/L) and PF 1+2 (791±632; reference range 69–229 ng/mL) normalised at 120 days post-TAVI Conclusion This study demonstrated that in the cohort of patients undergoing transfemoral TAVI in our centre: younger age, poor ejection fraction, atrial fibrillation and increased baseline eccentricity of the aortic valve annulus were present to a greater extent in patients exhibiting elevated transvalvular gradients at 3-month follow-up. Further work is required to delineate the extent of coagulation derangement and confirm predictors of thrombosis. All data relevant to the study are included in the article or uploaded as online supplemental information.

中文翻译：

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经导管主动脉瓣植入术后凝血紊乱和瓣膜血栓形成的危险因素

目的 经导管主动脉瓣植入术 (TAVI) 的耐用性是其扩张的关键。我们试图通过 TAVI 前和 TAVI 后相关的凝血测试来确定我们单中心的瓣膜血栓形成的发生率和瓣膜血栓形成的预测因素。方法和结果 这项单中心观察性研究包括在心脏团队会议上讨论的接受经股动脉 TAVI 的患者。在 120 天时对患者进行超声心动图随访以确定跨瓣压差升高的发生率，并进行多变量分析以确定与发生瓣膜血栓形成几率增加相关的因素。此外，11 名患者接受了基线、TAVI 后第 1 天和第 120 天的凝血测试。2017 年 8 月至 2019 年 8 月期间，437 名连续患者接受了经股动脉 TAVI。在这些患者中，207/437 (47.4%) 有 3 个月的随访回波数据可用并进行了分析。在这些患者中，26/207 (12.6%) 的跨瓣压差升高。这些患者往往更年轻（80±14 岁 vs 83±6 岁；p=0.047），射血分数较低（49±13 vs 54%±11%；p=0.021），更大比例的人群经历心房颤动（14/21，54% 对 68/181，38%；p=0.067）。在多变量分析之后，仍然存在与升高的梯度相关的偏心率指数更高的趋势。基线（TAVI 前）凝血酶抗凝血酶水平升高（56±63；参考范围 1.0–4.1 ng/L）和 PF 1+2（791±632；参考范围 69–229 ng/mL）在术后 120 天标准化TAVI 结论 本研究表明，在我们中心接受经股 TAVI 的患者队列中：年龄较小、射血分数低、在 3 个月的随访中表现出升高的跨瓣压差的患者中，房颤和主动脉瓣环的基线偏心率增加的程度更高。需要进一步的工作来描述凝血紊乱的程度并确认血栓形成的预测因素。与研究相关的所有数据都包含在文章中或作为在线补充信息上传。