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<p>Hypoattenuated leaflet thickening (HALT) represents a&#xa0;subclinical form of bioprosthetic aortic valve thrombosis that was first described in 2015 in the context of transcatheter aortic valve implantation (TAVI). In the present study 327 patients who underwent biological Bentall procedures with proximal aortic arch replacement under hypothermic circulatory arrest between January 2016 and December 2022 were analyzed. The HALT was diagnosed using sequential, electrocardiography (ECG)-gated computed tomography (CT) angiography. The analysis focused on the incidence, the occurrence of neurological events, transvalvular gradients, the perioperative use of hemostatic agents and postoperative management. The median follow-up was 3.27 years. Radiological evidence of HALT was identified in 28% of patients. Individuals with HALT exhibited a&#xa0;higher rate of transient neurological events, whereas overt stroke was rare. No significant differences were observed between patients with and without HALT regarding transvalvular gradients or postoperative anticoagulation strategies; however, a&#xa0;higher intraoperative use of hemostatic products was noted among patients with HALT, particularly regarding prothrombin complex concentrate. These findings suggest that HALT may occur more frequently following complex aortic root and arch surgery than previously assumed and could be associated with reversible neurological symptoms. The results highlight the need for prospective studies, standardized diagnostic approaches and a&#xa0;focused evaluation of perioperative risk factors to further elucidate the pathophysiology, clinical relevance and preventive strategies for HALT.</p>

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Perioperative Prädiktoren und klinische Outcomes der hypoattenuierten Segelverdickung nach Aortenwurzel- und Aortenbogenersatz

  • 期刊论文

  • 发表日期：

    2026年4月27日

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  • Caroline Radner,
  • Linda Grefen,
  • Josephine Guba,
  • Joscha Buech,
  • Thomas Fabry,
  • Christian Hagl,
  • Sven Peterss,
  • Maximilian Pichlmaier

摘要

Hypoattenuated leaflet thickening (HALT) represents a subclinical form of bioprosthetic aortic valve thrombosis that was first described in 2015 in the context of transcatheter aortic valve implantation (TAVI). In the present study 327 patients who underwent biological Bentall procedures with proximal aortic arch replacement under hypothermic circulatory arrest between January 2016 and December 2022 were analyzed. The HALT was diagnosed using sequential, electrocardiography (ECG)-gated computed tomography (CT) angiography. The analysis focused on the incidence, the occurrence of neurological events, transvalvular gradients, the perioperative use of hemostatic agents and postoperative management. The median follow-up was 3.27 years. Radiological evidence of HALT was identified in 28% of patients. Individuals with HALT exhibited a higher rate of transient neurological events, whereas overt stroke was rare. No significant differences were observed between patients with and without HALT regarding transvalvular gradients or postoperative anticoagulation strategies; however, a higher intraoperative use of hemostatic products was noted among patients with HALT, particularly regarding prothrombin complex concentrate. These findings suggest that HALT may occur more frequently following complex aortic root and arch surgery than previously assumed and could be associated with reversible neurological symptoms. The results highlight the need for prospective studies, standardized diagnostic approaches and a focused evaluation of perioperative risk factors to further elucidate the pathophysiology, clinical relevance and preventive strategies for HALT.