Aims: Hypoattenuated leaflet thickening (HALT) after transcatheter aortic valve implantation (TAVI) is associated with symptomatic hemodynamic valve deterioration. We sought to investigate the prosthetic valve performance in patients on antiplatelet therapy (APT) without symptomatic valve deterioration during long-term follow-up.

Methods and Results: For this retrospective observational study, 19 patients with HALT on routine post-TAVI-CTA between May 2012 and December 2017 and a mean follow up time of 4.66 [interquartile range 3.77-5.30] years were included. Patients with hemodynamic valve deterioration or death within three years after TAVI were excluded from the analysis. Mean age at the time of hospitalization for TAVI was 79.5 (SD 7.7) years. In the initial echocardiographic examination the prosthetic doppler velocity index (DVI=LVOTV_max/ProsthesisV_max) was 0.52 (±0.14), the mean pressure gradient (MPG) was 10.1(±5.3) mmHg and the maximum flow velocity was 2.29 (±0.48) m/s. During follow-up there were no changes in the DVI (ΔDVI 0.06±0.18, P=0.193) and the MPG (ΔMPG -1.3±3.4 mmHg, P=0.148). However, Vmax decreased (ΔVmax -0.23±0.30 m/s) significantly (P= 0.009).

Conclusions: In patients with early HALT on standard APT without symptomatic hemodynamic valve deterioration, valve performance did not worsen during a follow-up of more than 4.5 years.