Bioprosthesis leaflet thrombosis following self-expanding valve-in-valve transcatheter aortic valve replacement in patient taking factor Xa inhibitor and warfarin: A case report

An 87-year-old female with symptomatic severe aortic stenosis underwent transcatheter valve replacement (TAVR) via the transfemoral approach with a 29 mm self-expanding device. Moderate to severe paravalvular regurgitation led to the development of congestive heart failure and hospital readmission 1 month following TAVR. A second 29 mm valve was placed to abolish the paravalvular regurgitation. Routine follow-up computed tomography (CT) imaging demonstrated leaflet thickening and decreased leaflet mobility suggesting valve thrombosis, despite adherence to Factor Xa inhibitor. Transthoracic echocardiogram revealed normal transaortic valve gradients. The patient was transitioned to a vitamin K antagonist and repeat imaging 3 months later demonstrated progression of thrombosis to an additional leaflet. The case illustrates the potential increased risk of leaflet thrombosis in patients receiving valve-in-valve TAVR procedures, the superiority of multidetector computed tomography to image subclinical leaflet thrombosis, and highlights the need for further investigation in this area.