This is a prospective study designed to evaluate the structural and functional integrity of
transcatheter or surgical bioprosthetic valves with multimodality imaging. The study further
aims to confirm resolution of the early bioprosthetic valve thrombotic changes with Vitamin
K antagonists (warfarin) mediated anticoagulation therapy.
Patients with a history of SAVR or TAVR with bioprosthetic aortic valves undergo cardiac
contrast CT imaging and transthoracic echocardiography to evaluate structural and functional
integrity of the aortic valves. The imaging studies will be performed at least 48-hours
after TAVR/SAVR. Patients with prosthetic valve abnormalities suggestive of thrombus will be
administered anticoagulation therapy with Vitamin K antagonists (Warfarin) for 3 months with
goal International Normalized Ratio (INR) 2-3, followed by repeat contrast CT of the chest
and transthoracic imaging. Repeat imaging following 3 months of anticoagulation therapy is
performed to evaluate the response to anticoagulation therapy. INR levels will be monitored
and warfarin dose adjusted to maintain target INR 2-3.
- Presence of transcatheter or surgical bioprosthetic aortic valve implanted at least
48 hours prior to enrollment
- Age 18 years or older
- Ability to provide informed consent and follow-up with protocol procedures.
- Appearance of thrombotic changes in the bioprosthetic valves
- Renal insufficiency (creatinine > 1.5 mg/dL)
- Known allergy to iodinated contrast agents
Raj Makkar, MD
Cedars-Sinai Medical Center, Los Angeles, California
Tarun Chakravarty, MD