Title: Acute valve malfunction with thrombosed bioprosthetic valve after surgical aortic valve replacement

Author name: Hiroki Moriuchi, Masaaki Koide, Yoshifumi Kunii, Takuya Maeda, Risa Shimbori

Affiliations: SeireiHamamatsu Hospotal, Department of cardiovascular surgery

Key words: thrombus, bioprosthetic aortic valve

Corresponding author’s address: 2-12-12, Sumiyoshi, Nakaku, Hamamatsu, Shizuoka, Japan

Email: porimori22@gmail.com

AUTHOR CONTRIBUTIONS

Masaaki Koide and Takuya Maeda involved in review and editing.

ACKNOWLEDGEMENTS

I appreciate Mr. Andrew for reviewing manuscript and Yuki Moriuchi for total support.

FUNDING INFORMATION

None

CONFLICT OF INTEREST STATEMENT

The authors report no conflict of interest.

DATA AVAILABILITY STATEMENT

None

CONSENT STATEMENT

Written informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy.

CASE PRESENTATION

A 74-year-old man with chest pain was diagnosed with Stanford A acute aortic dissection and severe aortic regurgitation. Aortic valve replacement with a 21mm INSPIRIS (Edwards Lifesciences, Irvine, CA, USA) and ascending aortic replacement with 26mm J Graft (Japan Lifeline, Tokyo) was performed. Anticoagulation therapy using heparin and warfarin was started immediately. Postoperative Computed tomography(CT) revealed thrombus formation to all leaflets of the implanted valve(Figure1) and echocardiography revealed restricted leaflet motion, so surgical thrombectomy was performed. Abundant fresh thrombi adhered to all leaflets of the bioprosthetic valve, and those thrombi were carefully removed (Figure2). No damage or macroscopic degeneration on the leaflets were seen, so the implanted valve was preserved. We initiated argatoroban for 1 week, followed by aspirin and warfarin and postoperative CT showed no sign of thrombus. (Figure 3).

We previously reported leaflet and coronary stent thrombosis after TAVR², but acute bioprosthetic valve thrombosis after SAVR is extremely rare.¹

Reference

1. Cahill TJ, Khalique OK, Geourge Im et al. Valve thrombosis after transcatheter and surgical aortic valve replacement: Incidence and outcomes. J Thorac Cardiovasc Surg. 2022 Apr;163(4):1309-1315.

2. Satoshi O, Masaaki K, Yoshifumi K, et al. Leaflet and coronary stent thrombosis after transcatheter aortic valve implantation treated by aortic valve replacement. Eur Heart J Cardiovasc Imaging. 2020 Mar 1;21(3):347

Figure legends

Figure1: Computed tomography(CT) shows thrombi in all leaflets

Figure2: All thrombi were removed completely

Figure3: Postoperative CT shows no thrombus in bioprosthetic aortic valve

Key Clinical Message

Acute valve thrombosis after bioprosthetic aortic valve replacement even under appropriate anticoagulation therapy is extremely rare. Cardiac CT is a powerful imaging tool to detect valve thrombosis after both TAVR and SAVR.