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Journal of Thrombosis and Thrombolysis

, Volume 35, Issue 4, pp 456–462 | Cite as

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

  • Thomas Pilgrim
  • Stefan Stortecky
  • Fabienne Luterbacher
  • Stephan Windecker
  • Peter WenaweserEmail author
Article

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.

Keywords

Access site complication Bleeding TAVI 

Notes

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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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Thomas Pilgrim
    • 1
  • Stefan Stortecky
    • 1
  • Fabienne Luterbacher
    • 1
  • Stephan Windecker
    • 1
  • Peter Wenaweser
    • 1
    Email author
  1. 1.Department of Cardiology, Swiss Cardiovascular CenterBern University HospitalBernSwitzerland

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