Raffaele Piccolo1, Thomas Pilgrim1, Anna Franzone1, Marco Valgimigli1, Alan Haynes2, Masahiko Asami1, Jonas Lanz1, Lorenz Räber1, Fabien Praz1, Bettina Langhammer3, Eva Roost3, Stephan Windecker1, Stefan Stortecky4. 1. Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland. 2. Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland. 3. Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland. 4. Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland. Electronic address: stefan.stortecky@insel.ch.
Abstract
OBJECTIVES: The aim of this study was to examine the frequency, timing, and association of access-site and non-access-site bleeding with mortality in the setting of transcatheter aortic valve replacement (TAVR) during long-term follow-up. BACKGROUND: Bleeding is frequent and associated with impaired prognosis in patients undergoing TAVR. It is currently unknown whether the site of bleeding differentially influences the outcomes of TAVR patients. METHODS: In total, 926 consecutive patients undergoing TAVR from 2007 through 2014 were evaluated. Bleeding was assessed according to the Valve Academic Research Consortium 2 criteria. The primary outcome of interest was all-cause mortality up to 5 years of follow-up. RESULTS: A total of 285 patients (30.7%) experienced at least 1 (minor, major, or life-threatening) bleeding event up to 5 years. Compared with patients not experiencing bleeding, the adjusted risk for all-cause mortality was significantly increased among patients with access-site (hazard ratio: 1.34; 95% confidence interval: 1.01 to 1.76; p = 0.04) and non-access-site bleeding (hazard ratio: 2.08; 95% confidence interval: 1.60 to 2.71; p < 0.001). However, non-access-site bleeding conferred a significantly higher risk for mortality compared with access-site bleeding (hazard ratio: 1.56; 95% confidence interval: 1.12 to 2.18; p = 0.009). At multivariate analysis, female sex was a significant correlate of access-site bleeding, whereas chronic kidney disease and the Society of Thoracic Surgeons score were significantly associated with non-access-site bleeding. CONCLUSIONS: Among patients with severe aortic stenosis undergoing TAVR, access-site and non-access-site bleeding were independently associated with an increased risk for mortality, with the greatest risk related to non-access-site bleeding during long-term follow-up.
OBJECTIVES: The aim of this study was to examine the frequency, timing, and association of access-site and non-access-site bleeding with mortality in the setting of transcatheter aortic valve replacement (TAVR) during long-term follow-up. BACKGROUND: Bleeding is frequent and associated with impaired prognosis in patients undergoing TAVR. It is currently unknown whether the site of bleeding differentially influences the outcomes of TAVR patients. METHODS: In total, 926 consecutive patients undergoing TAVR from 2007 through 2014 were evaluated. Bleeding was assessed according to the Valve Academic Research Consortium 2 criteria. The primary outcome of interest was all-cause mortality up to 5 years of follow-up. RESULTS: A total of 285 patients (30.7%) experienced at least 1 (minor, major, or life-threatening) bleeding event up to 5 years. Compared with patients not experiencing bleeding, the adjusted risk for all-cause mortality was significantly increased among patients with access-site (hazard ratio: 1.34; 95% confidence interval: 1.01 to 1.76; p = 0.04) and non-access-site bleeding (hazard ratio: 2.08; 95% confidence interval: 1.60 to 2.71; p < 0.001). However, non-access-site bleeding conferred a significantly higher risk for mortality compared with access-site bleeding (hazard ratio: 1.56; 95% confidence interval: 1.12 to 2.18; p = 0.009). At multivariate analysis, female sex was a significant correlate of access-site bleeding, whereas chronic kidney disease and the Society of Thoracic Surgeons score were significantly associated with non-access-site bleeding. CONCLUSIONS: Among patients with severe aortic stenosis undergoing TAVR, access-site and non-access-site bleeding were independently associated with an increased risk for mortality, with the greatest risk related to non-access-site bleeding during long-term follow-up.
Authors: Angela Lowenstern; Steven J Lippmann; J Matthew Brennan; Tracy Y Wang; Lesley H Curtis; Ted Feldman; Donald D Glower; Bradley G Hammill; Sreekanth Vemulapalli Journal: Circ Cardiovasc Interv Date: 2019-05 Impact factor: 6.546
Authors: Binita Shah; Pedro A Villablanca; Sreekanth Vemulapalli; Pratik Manandhar; Nicholas S Amoroso; Muhamed Saric; Cezar Staniloae; Mathew R Williams Journal: Circ Cardiovasc Interv Date: 2019-02 Impact factor: 6.546