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Transcatheter aortic valve implantation and bleeding: incidence, predictors and prognosis

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Abstract

Peri-procedural bleeding complications are feared adverse events in patients undergoing transcatheter aortic valve implantation (TAVI). Little is known about the implications of peri-procedural bleeding on clinical outcome. In a prospective single-center registry of consecutive patients undergoing TAVI, we investigated incidence, predictors and clinical consequences of life-threatening and major bleeding as defined by the Valve Academic Research Consortium. Among 389 consecutive patients undergoing TAVI by a transfemoral (79.2 %), transapical (19.6 %) or trans-subclavian (1.3 %) approach between July 2007 and October 2011, life-threatening or major peri-procedural bleeding events occurred in 64 (16.4 %) and 125 patients (32.1 %), respectively. Patients with peri-procedural bleeding events had a higher logistic EuroSCORE, more advanced renal disease, and were more symptomatic as assessed by New York Heart Association functional class at baseline as compared to patients with no bleeding. Life-threatening bleeding was associated with a higher all-cause (17.2 vs 5.6 vs 3.0 %, p < 0.001) and cardiovascular mortality (10.9 vs 5.6 vs 2.5 %, p = 0.02) at 30 days compared to patients with major bleeding or no bleeding. Multivariate analysis identified transapical access (OR 2.6, 95 % CI 1.4–4.8; p = 0.002), glomerular filtration rate <30 ml/min (OR 2.3, 95 % CI 1.1–4.7, p = 0.031), and diabetes (OR 1.8, 95 % CI 1.001–3.2, p = 0.049) as independent predictors of life-threatening, peri-procedural bleeding. Life-threatening bleeding complications in patients undergoing TAVI are associated with increased mortality. Renal impairment, diabetes, and transapical approach were identified as independent risk factors for life-threatening bleeding events.

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Disclosures

Drs. Windecker and Wenaweser are Proctors for Medtronic CoreValve and Edwards Lifesciences. Supported by an unrestricted research grant of Medtronic to the University of Berne.

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Authors and Affiliations

  1. Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland

    Thomas Pilgrim, Stefan Stortecky, Fabienne Luterbacher, Stephan Windecker & Peter Wenaweser

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  1. Thomas Pilgrim
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  2. Stefan Stortecky
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  3. Fabienne Luterbacher
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  4. Stephan Windecker
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  5. Peter Wenaweser
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Correspondence to Peter Wenaweser.

Additional information

T. Pilgrim and S. Stortecky contributed equally to this study.

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Pilgrim, T., Stortecky, S., Luterbacher, F. et al. Transcatheter aortic valve implantation and bleeding: incidence, predictors and prognosis. J Thromb Thrombolysis 35, 456–462 (2013). https://doi.org/10.1007/s11239-012-0842-3

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  • DOI: https://doi.org/10.1007/s11239-012-0842-3

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