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 bioprosthetic valve replacement 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
bioprosthetic valve replacement. 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