Subclinical Leaflet Thrombosis and Clinical Outcomes after TAVR: A Systematic Review and Meta-Analysis

ABSTRACTBackground: Little is known about the influence of subclinical leaflet thrombosis (SCLT) on clinical outcomes after transcatheter aortic valve replacement (TAVR). Therefore, we sought to perform a systematic review and meta-analysis of studies that reported clinical outcomes in patients with or without SCLT after TAVR.Methods: We searched Medline, PubMed, and Embase in September 2017 for studies reporting the clinical outcomes in patients with or without SCLT after TAVR. SCLT was defined as the presence of hypo-attenuated leaflet thickening (HALT) and/or hypo-attenuation affecting leaflet motion (HAM) shown on computed tomography. End-points studied included (1) mortality; (2) stroke; and (3) stroke and/or TIA. Odds ratio (OR) meta-analysis was conducted by the Peto method using a random effects model; results are presented at the 95% confidence level.Results: A total of five studies (91 patients with SCLT; 672 patients without SCLT) met the inclusion criteria. Pooled incidence of SCLT was 15.2% (...