Antithrombotic Treatment After Valve-in-Valve, Valve-in-Ring, and Valve-in-MAC Procedures: A Systematic Review and Meta-Analysis

Gonçalo Batista; Gonçalo Costa; Joana Delgado Silva; Lino Gonçalves

doi:10.20344/amp.22905

Autores

Gonçalo Batista Serviço de Cardiologia. Centro Hospitalar e Universitário de Coimbra. Coimbra.
Gonçalo Costa Serviço de Cardiologia. Centro Hospitalar e Universitário de Coimbra. Coimbra. & Faculdade de Medicina. Universidade de Coimbra. Coimbra. & Coimbra Institute for Clinical and Biomedical Research (iCBR). Coimbra.
Joana Delgado Silva Serviço de Cardiologia. Centro Hospitalar e Universitário de Coimbra. Coimbra. & Faculdade de Medicina. Universidade de Coimbra. Coimbra. & Coimbra Institute for Clinical and Biomedical Research (iCBR). Coimbra.
Lino Gonçalves Serviço de Cardiologia. Centro Hospitalar e Universitário de Coimbra. Coimbra. & Faculdade de Medicina. Universidade de Coimbra. Coimbra. & Coimbra Institute for Clinical and Biomedical Research (iCBR). Coimbra.

DOI:

https://doi.org/10.20344/amp.22905

Palavras-chave:

Anticoagulantes/administração e dosagem, Bioprótese, Cateterismo Cardíaco, Implante de Prótese de Válvula Cardíaca, Trombose/prevenção e controlo

Resumo

Introdução: Embora a terapêutica antitrombótica após a implantação de válvulas percutâneas tenha sido amplamente estudada em diversos ensaios clínicos, persiste uma lacuna significativa quanto à abordagem ideal após os procedimentos valve-in-valve (ViV), valve-in-ring (ViR) e valve-in-mitral annular calcification (ViMAC). Essa lacuna é particularmente relevante devido ao aparente aumento do risco trombótico associado aos procedimentos ViV. O objectivo desta revisão sistemática foi explorar os potenciais benefícios da anticoagulação em procedimentos ViV, ViR e ViMAC
Métodos: Foi feita uma pesquisa na PubMed, Embase, Cochrane Central Register of Controlled Trials, bem como da literatura cinzenta, para estudos observacionais e intervencionais publicados até dezembro de 2023. Foram incluídos estudos que realizaram uma análise comparativa entre uma estratégia anticoagulante e uma estratégia antiagregante, sendo excluídos aqueles que incluíram doentes com menos de 18 anos. O outcome primário de eficácia foi definido como a incidência de trombose valvular (TV) clínica e total. O outcome primário de segurança foi hemorragia major. Foram feitas análises adicionais relativamente à posição mitral e de acordo com o tipo de válvula utilizada. O risco de viés foi avaliado utilizando a escala de Newcastle-Ottawa. Os dados foram analisados com o software Review Manager 5.4.
Resultados: Foram incluídos cinco estudos observacionais e uma case-series (n = 614 sob anticoagulação e n = 468 sob antiagregantes), num total de 1082 participantes. A taxa de TV clínica foi de 4,2% para todos os procedimentos, e os doentes sob anticoagulação apresentaram uma redução significativa da TV clínica (1,1% vs 8,3%; OR: 0,18; IC 95%: 0,07 - 0,42; I²: 0%) e da TV total (1,3% vs 8,5%; OR: 0,16; IC 95%: 0,07 - 0,37; I²: 0%). Em relação aos eventos hemorrágicos, os dados disponíveis na literatura não permitiram uma análise adequada.
Conclusão: O nosso estudo sugere um potencial benefício potencial dos regimes anticoagulantes na redução das elevadas taxas de TV após os procedimentos valve-in-valve, valve-in-ring e valve-in-mitral annular calcification. No entanto, a ausência de ensaios clínicos randomizados e de dados sobre hemorragias e mortalidade reforça a necessidade de mais investigação.

Downloads

Não há dados estatísticos.

Referências

Kiyose AT, Suzumura EA, Laranjeira L, Buehler AM, Santo JA, Berwanger O, et al. Comparison of biological and mechanical prostheses for heart valve surgery: a systematic review of randomized controlled trials. Arq Bras Cardiol. 2019;112:292-301. DOI: https://doi.org/10.5935/abc.20180272

Bartus K, Sadowski J, Litwinowicz R, Filip G, Jasinski M, Deja M, et al. Changing trends in aortic valve procedures over the past ten years—from mechanical prosthesis via stented bioprosthesis to TAVI procedures—analysis of 50,846 aortic valve cases based on a Polish National Cardiac Surgery Database. J Thorac Dis. 2019;11:2340-9. DOI: https://doi.org/10.21037/jtd.2019.06.04

Rodriguez-Gabella T, Voisine P, Puri R, Pibarot P, Rodés-Cabau J. Aortic bioprosthetic valve durability. J Am Coll Cardiol. 2017;70:1013-28. DOI: https://doi.org/10.1016/j.jacc.2017.07.715

Yoon SH, Whisenant BK, Bleiziffer S, Delgado V, Dhoble A, Schofer N, et al. Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification. Eur Heart J. 2019;40:441-51. DOI: https://doi.org/10.1093/eurheartj/ehy590

Bruno F, Elia E, D’Ascenzo F, Marengo G, Deharo P, Kaneko T, et al. Valve-in-valve transcatheter aortic valve replacement or re-surgical aortic valve replacement in degenerated bioprostheses: a systematic review and meta-analysis of short and midterm results. Catheter Cardiovasc Interv. 2022;100:122-30. DOI: https://doi.org/10.1002/ccd.30219

Kilic A, Acker MA, Gleason TG, Sultan I, Vemulapalli S, Thibault D, et al. Clinical outcomes of mitral valve reoperations in the United States: an analysis of the society of thoracic surgeons national database. Ann Thorac Surg. 2019;107:754-9. DOI: https://doi.org/10.1016/j.athoracsur.2018.08.083

Xu X, Liu H, Gu J, Li M, Shao Y. Valve-in-valve/valve-in-ring transcatheter mitral valve implantation vs. redo surgical mitral valve replacement for patients with failed bioprosthetic valves or annuloplasty rings: a systematic review and meta-analysis. Heliyon. 2023;9:e16078. DOI: https://doi.org/10.1016/j.heliyon.2023.e16078

Sá MP, Eynde J Van den, Simonato M, Cavalcanti LR, Doulamis IP, Weixler V, et al. Valve-in-valve transcatheter aortic valve replacement versus redo surgical aortic valve replacement. JACC Cardiovasc Interv. 2021;14:211-20. DOI: https://doi.org/10.1016/j.jcin.2020.10.020

Ahmad D, Yousef S, Kliner D, Brown JA, Serna-Gallegos D, Toma C, et al. Outcomes of valve-in-valve transcatheter aortic valve replacement. Am J Cardiol. 2024;215:1-7. DOI: https://doi.org/10.1016/j.amjcard.2023.12.061

Collet JP, Belle EV, Thiele H, Berti S, Lhermusier T, Manigold T, et al. Apixaban vs. standard of care after transcatheter aortic valve implantation: the ATLANTIS trial. Eur Heart J. 2022;43:2783-97. DOI: https://doi.org/10.1093/eurheartj/ehac408

Dangas GD, Tijssen JG, Wöhrle J, Søndergaard L, Gilard M, Möllmann H, et al. A controlled trial of rivaroxaban after transcatheter aortic-valve replacement. N Engl J Med. 2020;382:120-9. DOI: https://doi.org/10.1056/NEJMoa1911425

Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2022;43:561-632.

Mehilli J, Giannini C. Transcatheter valve-in-valve implantation for failed surgical bioprostheses – some answers and many unanswered questions. EuroIntervention. 2020;16:529-31. DOI: https://doi.org/10.4244/EIJV16I7A97

Rheude T, Pellegrini C, Cassese S, Wiebe J, Wagner S, Trenkwalder T, et al. Predictors of haemodynamic structural valve deterioration following transcatheter aortic valve implantation with latest-generation balloon-expandable valves. EuroIntervention. 2020;15:1233-9. DOI: https://doi.org/10.4244/EIJ-D-19-00710

Aktuerk D, Mirsadraee S, Quarto C, Davies S, Duncan A. Leaflet thrombosis after valve-in-valve transcatheter aortic valve implantation: a case series. Eur Heart J Case Rep. 2020;4:1-6. DOI: https://doi.org/10.1093/ehjcr/ytaa221

Notaristefano F, Reccia MR, Notaristefano S, Annunziata R, Sclafani R, Ambrosio G, et al. Bailout surgical explantation of a transcatheter valve-in-valve for subacute thrombosis: when there is no time for anticoagulation. Cardiovasc Revasc Med. 2018;19:536-9. DOI: https://doi.org/10.1016/j.carrev.2017.12.005

Chu J, Nath N, Attanasio S. Thrombolysis for cardiogenic shock secondary to aortic bioprosthetic valve-in-valve thrombosis. Cureus. 2022;14:e33141. DOI: https://doi.org/10.7759/cureus.33141

Rosseel L, Backer OD, Søndergaard L. Clinical valve thrombosis and subclinical leaflet thrombosis following transcatheter aortic valve replacement: is there a need for a patient-tailored antithrombotic therapy? Front Cardiovasc Med. 2019;6:44. DOI: https://doi.org/10.3389/fcvm.2019.00044

Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, et al. Standardized bleeding definitions for cardiovascular clinical trials. Circulation. 2011;123:2736-47. DOI: https://doi.org/10.1161/CIRCULATIONAHA.110.009449

Montalescot G, Redheuil A, Vincent F, Desch S, Benedictis M De, Eltchaninoff H, et al. Apixaban and valve thrombosis after transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2022;15:1794-804. DOI: https://doi.org/10.1016/j.jcin.2022.07.014

Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2022;43:561-632. DOI: https://doi.org/10.1093/ejcts/ezac209

Jose J, Sulimov DS, El-Mawardy M, Sato T, Allali A, Holy EW, et al. Clinical bioprosthetic heart valve thrombosis after transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2017;10:686-97. DOI: https://doi.org/10.1016/j.jcin.2017.01.045

Vahidkhah K, Javani S, Abbasi M, Azadani PN, Tandar A, Dvir D, et al. Blood stasis on transcatheter valve leaflets and implications for valve-in-valve leaflet thrombosis. Ann Thorac Surg. 2017;104:751-9. DOI: https://doi.org/10.1016/j.athoracsur.2017.02.052

Mangione FM, Jatene T, Gonçalves A, Fishbein GA, Mitchell RN, Pelletier MP, et al. Leaflet thrombosis in surgically explanted or post-mortem TAVR valves. JACC Cardiovasc Imaging. 2017;10:82-5. DOI: https://doi.org/10.1016/j.jcmg.2016.11.009

Dangas GD, Weitz JI, Giustino G, Makkar R, Mehran R. Prosthetic heart valve thrombosis. J Am Coll Cardiol. 2016;68:2670-89. DOI: https://doi.org/10.1016/j.jacc.2016.09.958

Brown ML, Park SJ, Sundt TM, Schaff HV. Early thrombosis risk in patients with biologic valves in the aortic position. J Thorac Cardiovasc Surg 2012;144:108-111. DOI: https://doi.org/10.1016/j.jtcvs.2011.05.032

Khan JM, Dvir D, Greenbaum AB, Babaliaros VC, Rogers T, Aldea G, et al. Transcatheter laceration of aortic leaflets to prevent coronary obstruction during transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2018;11:677-89. DOI: https://doi.org/10.1016/j.jcin.2018.01.247

Plitman Mayo R, Yaakobovich H, Finkelstein A, Shadden SC, Marom G. Impact of BASILICA on the thrombogenicity potential of valve-in-valve implantations. J Biomech. 2021;118:110309. DOI: https://doi.org/10.1016/j.jbiomech.2021.110309

Eng MH, Kargoli F, Wang DD, Frisoli TM, Lee JC, Villablanca PS, et al. Short- and mid-term outcomes in percutaneous mitral valve replacement using balloon expandable valves. Catheter Cardiovasc Interv. 2021;98:1193-203. DOI: https://doi.org/10.1002/ccd.29783

McElhinney DB, Aboulhosn JA, Dvir D, Whisenant B, Zhang Y, Eicken A, et al. Mid-term valve-related outcomes after transcatheter tricuspid valve-in-valve or valve-in-ring replacement. J Am Coll Cardiol. 2019;73:148-57. DOI: https://doi.org/10.1016/j.jacc.2018.10.051

Abdel-Wahab M, Simonato M, Latib A, Goleski PJ, Allali A, Kaur J, et al. Clinical valve thrombosis after transcatheter aortic valve-in-valve implantation. Circ Cardiovasc Interv. 2018;11:e006730. DOI: https://doi.org/10.1161/CIRCINTERVENTIONS.118.006730

Eng MH, Greenbaum A, Wang DD, Wyman JD, Arjomand H, Yadav P, et al. Thrombotic valvular dysfunction with transcatheter mitral interventions for postsurgical failures. Catheter Cardiovasc Interv. 2017;90:321-8. DOI: https://doi.org/10.1002/ccd.26909

Whisenant B, Jones K, Miller D, Horton S, Miner E. Thrombosis following mitral and tricuspid valve-in-valve replacement. J Thorac Cardiovasc Surg. 2015;149:e269. DOI: https://doi.org/10.1016/j.jtcvs.2014.10.075