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

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

In: Journal of Thrombosis and Thrombolysis, 2013, vol. 35, no. 4, p. 456-462

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    Titre
    • Transcatheter aortic valve implantation and bleeding: incidence, predictors and prognosis
    Auteur
    • Pilgrim, Thomas. Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
    • Stortecky, Stefan. Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
    • Luterbacher, Fabienne. Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
    • Windecker, Stephan. Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
    • Wenaweser, Peter. Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Journal of Thrombosis and Thrombolysis, 2013, vol. 35, no. 4, p. 456-462. Springer US; http://www.springer-ny.com
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:310046
    Summary
    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 30days 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 <30ml/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