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Research Summary

Primary Investigators: Tiffany Patterson, Prof Simon Redwood

Clinical Research Fellow and Co-PI: Harriet Hurrell

Collaborators: Prof Beverley Hunt, Prof Bernard Prendergast, Dr Jack Lee

Severe aortic stenosis carries a 50% mortality at two years. Trans-catheter aortic valve implantation (TAVI) has been superior to surgical aortic valve replacement in terms of early clinical outcomes for all risk cohorts. However, little is known about durability and there is concern regarding detection of leaflet thrombosis and reduced leaflet mobility in up to 15%. This has been associated with valve failure and stroke. Recent data demonstrates harm from routine anticoagulation in this cohort. However, we have no evidence to guide anti-thrombotic therapies or identify those at greater risk post TAVI. TAVI leaflet thrombosis is likely secondary to turbulent flow in the presence of pro-thrombotic state. We are investigating the mechanisms of leaflet thrombosis by measuring and comparing haemostatic, structural and clinical characteristics of patients with TAVI thrombosis with a matched control cohort without thrombosis to identify risk factors for TAVI thrombosis.

Biography

Tiffany Patterson is an NIHR Academic Clinical Lecturer and Interventional Fellow in Cardiology, training in coronary and structural interventions. Tiffany graduated from St Bartholomew’s and the Royal London School of Medicine with MBBS (Hons) and BMedSci (Hons) in 2005 and was awarded Membership of the Royal College of Physicians (MRCP) in 2009. She has trained in Interventional Cardiology at St Mary’s, Hammersmith, Royal Brompton, King’s College and St Thomas’ Hospitals in London. Tiffany was awarded a British Heart Foundation Clinical Research Training Fellowship in 2014 to support her PhD. Following the award of her PhD in 2017 in Cardiovascular Physiology (King’s College London), she was successfully awarded a Clinical Study Grant from the British Heart Foundation to perform a multicentre randomised control trial examining the pre-hospital management of patients following cardiac arrest: The ARREST Trial. She has a broad range of research interests in addition to cardiac arrest, including machine learning for determination of FFR during invasive coronary angiography and more recently, investigating the mechanisms of TAVI thrombosis through collaboration with our world-leading department of Haematology and Thrombosis at Guy’s and St Thomas and our biomedical engineers at KCL.

Valve related publications

Patterson T, Rajani R, Esposito G, Allen C, Adams H, Prendergast, Young C, Redwood SR. Valve-in-Valve Transcatheter Aortic Valve Implantation for Degenerative Perceval Sutureless Bioprosthesis Complicated by Aorto-Right Ventricular Fistula. JACC Case Rep. Accepted pending publication.

Costa G, De Backer O, Pilgrim T, Kasel M, Redwood S, Aminian A, Lanz J, Michel J, Patterson T, Windecker S, Prendergast B, Greenbaum AB, Søndergaard L. Initial European experience with transcaval transcatheter aortic valve implantation. EuroIntervention. 2019 Oct 29.

Adams HSL, Patterson T, Redwood S, Prendergast B. Prior Preparation Prevents Poor TAVR Performance. JACC Cardiovasc Interv. 2019 Sep 23;12(18):1778-1780.

Witberg G, Patterson T, Redwood S, Prendergast B. Future perspectives: Transcatheter Aortic Valve Implantation for Low Risk Patients: Inevitable Evolution or a Step Too Far? Rev Esp Cardiol (Engl Ed). 2019 Mar 28

Patterson T, Rajani R, Prendergast B, Redwood SR. Indirect mitral annuloplasty to treat functional mitral regurgitation: Current Results and Future Directions. Frontiers in Cardiovascular Medicine. 2019 May

Patterson T, Witberg G, Prendergast BD, Redwood SR. Editorial. Balloon valve fracture at the time of valve-in-valve TAVI – ex-vivo modelling and clinical implications. JACC Cardiovasc Interv. 2019 Jan 14;12(1):76-77.

Patterson T, Prendergast BD, Redwood SR. Editorial. PCI in TAVI: who, why and when? EuroIntervention. 2018 Dec 7;14(11):e1160-e1162