Possible Subclinical Leaflet Thrombosis in Bioprosthetic Aortic Valves

This is an important article and an important message. Especially in the rapidly growing TAVI community subclinical and also clinically relevant leaflet thromboses are more common than currently reported and - out of own experience - oftentimes misinterpreted as leaflet dysfunction. Therapeutic anticoagulation may indeed resolve many of these thrombi, however early and correct diagnosis is mandatory. The problem is even more pronounced in patients with hemodynamic instability and low flow phases immediately after surgery on the intensive care unit and may even become lifethreatening in patients under extracorporeal life support, as reported earlier. Propably we need randomized trials to find out, whether a limited oral anticoagulation in the early postoperative phase, as performed in many centers after conventional implantation of a bioprosthesis, should also be recommended for TAVI´s instead of a dual antiplatelet therapy.