Abstract 13333: Incidence, Predictors and Impact of Bleeding after Transcatheter Aortic Valve Implantation
Objectives: Data regarding the determinants and outcomes of bleeding after transcatheter aortic valve implantation (TAVI) are limited. The purpose of this study was to evaluate the incidence, predictors and impact of bleeding after TAVI.
Methods: We included 250 consecutive patients (Pts) implanted in our center between May 2006 and Oct 2011. All procedures were performed using the Edwards SAPIEN and SAPIEN XT valves, via transfemoral (TF) and transapical (TA) routes. Surgical cutdown was performed for TF access with the SAPIEN valve (22-24 Fr introducers), while percutaneous closure (Prostar) was used with the SAPIEN XT valve (18-19F introducers). Ascendra 1 (28F) and Ascendra 2 (26F) delivery systems were used for TA TAVI. Dual antiplatelet therapy was administered prior to TF implantation, aspirin only in TA cases, with 70 UI/kg of unfractionated heparin after sheath insertion. Bleeding and other complications were defined using VARC criteria.
Results: TAVI was performed via TF route in 190 cases (76%), and SAPIEN XT was used in 123 Pts (49.2%). Bleeding after TAVI was observed in 68 Pts (27.2%) as follows: life-threatening bleeding (LTB) in 33 (13.2%), major bleeding in 23 (9.2%) and minor bleeding in 12 (4.8%). Bleeding was access related in 70%. After multivariate analysis, only TA access was an independent predictor of LTB (OR 3.35, 95% CI: 1.52 - 7.38, p<0.003). Pts presenting LTB had higher 30-day mortality: 33.3% vs. 3.7%, p<0.001 and 1-year mortality:82% vs. 46%, p < 0.001 (Figure). LTB was an independent predictor of 30-day (OR 6.98, 95% CI: 1.93 - 25.1, p=0.003) and 1-year mortality (HR 2.18, 95% CI:1.11 - 4.28, p=0.024).
Conclusions: Bleeding after TAVI was observed in over 25% of cases and was mostly access-related. LTB was associated with higher 30-day and 1-year mortality.
- © 2012 by American Heart Association, Inc.