Incidence, predictors and prognostic value of serious hemorrhagic complications following transcatheter aortic valve implantation

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• 作者：Nicolas Amabile ; Alex ; re Azmoun ; Said Ghostine ; Ramzi Ramadan ; Yacine Haddouche ; Fran?ois Raoux ; Ngoc-Tram To ; Xavier Troussier ; Remi Nottin ; Christophe Caussin
• 关键词：Transcatheter aortic valve implantation ; Bleeding ; Prognosis
• 刊名：International Journal of Cardiology
• 出版年：2013
• 出版时间：20 September, 2013
• 年：2013
• 卷：168
• 期：1
• 页码：151-156
• 全文大小：308 K

文摘

Background

TAVI is an alternative solution for patients with aortic valve stenosis (AS) who are refused for conventional surgery. We sought to evaluate the incidence, characteristics, predictors and prognosis impact of serious hemorrhagic complications following transcatheter aortic valve implantation (TAVI).

Methods

One hundred and seventy one consecutive patients with symptomatic severe AS (83.5 ¡À 6.1 y; 53 % women; mean EuroSCORE = 22.1 ¡À 12.3) underwent transapical (TA) or transfemoral (TF) TAVI in our institution using Edwards SAPIEN? and Medtronic CoreValve? devices. The primary evaluated criterion was the incidence of any bleeding complication, according to the Valve Academic Research Consortium (VARC) criteria.

Results

VARC serious hemorrhagic complications occurred in 34.5 % of patients (n = 23 life-threatening/disabling (LT/D) and n = 36 major bleedings). Most of these complications were related to access site complications (69 % ). Multivariable analysis revealed that TA access, low weight and underlying coronary artery diseases were independent predictors for development of serious bleeding. The mortality was significantly higher in patients with serious events compared to patients without bleeding (p = 0.008, log-rank analysis). Although the survival didn't significantly differ in patients with major hemorrhagic events, subjects with LT/D bleeding events had a higher mortality than the subjects with no hemorrhagic complications (p < 0.001, log-rank analysis). Occurrence of VARC LT/D event independently predicted all-cause mortality (HR = 5.35 [2.51-11.43], p < 0.001) during the first year following TAVI in multivariate Cox regression analysis.

Conclusion

Severe bleeding is frequent following TAVI procedure and is mainly related to local hemorrhage. VARC LT/D events are associated with decreased survival after AS correction.