Marion Kibler1, Benjamin Marchandot1, Nathan Messas1, Julien Labreuche2, Flavien Vincent3, Lelia Grunebaum4, Viet Anh Hoang5, Antje Reydel1, Ulun Crimizade1, Michel Kindo1, Minh Tam Hoang1, Floriane Zeyons1, Annie Trinh1, Hélène Petit-Eisenmann1, Fabien De Poli6, Pierre Leddet6, Alain Duhamel2, Laurence Jesel7, Mickael Ohana8, Sophie Susen9, Patrick Ohlmann1, Eric Van Belle10, Olivier Morel11. 1. Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France. 2. Department of Biostatistics, Centre Hospitalier Universitaire, Lille, France. 3. CHU Lille, Institut Coeur-Poumon, Cardiology, Lille, France; University of Lille, INSERM U1011 - EGID, Institut Pasteur de Lille, Lille, France. 4. Department of Haemostasis, Centre Hospitalier Universitaire, Strasbourg, France. 5. Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam. 6. Department of Cardiology, Centre Hospitalier de Haguenau, Haguenau, France. 7. Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France; UMR 1260 INSERM Nanomédecine Régénérative, Université de Strasbourg, Strasbourg, France. 8. Department of Radiology, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France. 9. University of Lille, INSERM U1011 - EGID, Institut Pasteur de Lille, Lille, France; CHU Lille, Hematology Transfusion, Lille, France. 10. CHU Lille, Institut Coeur-Poumon, Cardiology, Lille, France; University of Lille, INSERM U1011 - EGID, Institut Pasteur de Lille, Lille, France. Electronic address: https://twitter.com/Eric_Van_Belle. 11. Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France; UMR 1260 INSERM Nanomédecine Régénérative, Université de Strasbourg, Strasbourg, France. Electronic address: olivier.morel@chru-strasbourg.fr.
Abstract
BACKGROUND: Periprocedural and late (>30 days) bleedings represent major complications after transcatheter aortic valve replacement and have been identified as potential areas for improved patient care. OBJECTIVES: The authors sought to evaluate the impact of ongoing primary hemostasis disorders on late major/life-threatening bleeding complications (MLBCs). METHODS: Bleedings were assessed according to the VARC-2 (Valve Academic Research Consortium-2) criteria. Closure time of adenosine diphosphate (CT-ADP), a surrogate marker of high molecular weight von Willebrand multimers proteolysis was assessed 24 h after the procedure. Ongoing primary hemostasis disorder was defined by a CT-ADP >180 s. RESULTS: Among 372 patients who survived at 30 days, MLBCs occurred in 42 patients (11.3%) at a median follow-up of 383 days (interquartile range: 188 to 574 days). MLBCs were mainly of gastrointestinal origin (42.8%) and were associated with increased overall mortality (hazard ratio [HR]: 5.66; 95% confidence interval [CI]: 3.10 to 10.31; p < 0.001) and cardiac mortality (HR: 11.62; 95% CI: 4.59 to 29.37; p < 0.001). A 2.5-fold elevation of MLBCs could be evidenced in patients with a CT-ADP > 180 s (27.4% vs. 11.5%; p < 0.001). Multivariate regression analysis identified paravalvular leak (PVL) (HR: 6.31; 95% CI: 3.43 to 11.60; p < 0.0001) and CT-ADP > 180 s (HR: 3.08; 95% CI: 1.62 to 5.81; p = 0.0005) as predictor of MLBCs. CONCLUSIONS: MLBCs after transcatheter aortic valve replacement are frequent and associated with an increased morbidity and mortality. PVL and CT-ADP >180 s were identified as strong predictors for MLBCs. These findings strongly suggest that persistent HMW defects contribute to enhanced bleeding risk in patients with residual PVL.
BACKGROUND: Periprocedural and late (>30 days) bleedings represent major complications after transcatheter aortic valve replacement and have been identified as potential areas for improved patient care. OBJECTIVES: The authors sought to evaluate the impact of ongoing primary hemostasis disorders on late major/life-threatening bleeding complications (MLBCs). METHODS: Bleedings were assessed according to the VARC-2 (Valve Academic Research Consortium-2) criteria. Closure time of adenosine diphosphate (CT-ADP), a surrogate marker of high molecular weight von Willebrand multimers proteolysis was assessed 24 h after the procedure. Ongoing primary hemostasis disorder was defined by a CT-ADP >180 s. RESULTS: Among 372 patients who survived at 30 days, MLBCs occurred in 42 patients (11.3%) at a median follow-up of 383 days (interquartile range: 188 to 574 days). MLBCs were mainly of gastrointestinal origin (42.8%) and were associated with increased overall mortality (hazard ratio [HR]: 5.66; 95% confidence interval [CI]: 3.10 to 10.31; p < 0.001) and cardiac mortality (HR: 11.62; 95% CI: 4.59 to 29.37; p < 0.001). A 2.5-fold elevation of MLBCs could be evidenced in patients with a CT-ADP > 180 s (27.4% vs. 11.5%; p < 0.001). Multivariate regression analysis identified paravalvular leak (PVL) (HR: 6.31; 95% CI: 3.43 to 11.60; p < 0.0001) and CT-ADP > 180 s (HR: 3.08; 95% CI: 1.62 to 5.81; p = 0.0005) as predictor of MLBCs. CONCLUSIONS: MLBCs after transcatheter aortic valve replacement are frequent and associated with an increased morbidity and mortality. PVL and CT-ADP >180 s were identified as strong predictors for MLBCs. These findings strongly suggest that persistent HMW defects contribute to enhanced bleeding risk in patients with residual PVL.
Authors: Harold L Dauerman; Christine M DeStephan; Heidi Taatjes Sommer; Kathryn C Kurchena; Michael DeSarno; Erika G Mendoza; Amy Henderson; David J Schneider Journal: J Am Coll Cardiol Date: 2019-08-13 Impact factor: 24.094
Authors: Lia C M J Goltstein; Maxim J P Rooijakkers; Natasha C C Görtjes; Reinier P Akkermans; Erwin S Zegers; Ron Pisters; Marleen H van Wely; Kees van der Wulp; Joost P H Drenth; Erwin J M van Geenen; Niels van Royen Journal: Circ Cardiovasc Interv Date: 2022-07-05 Impact factor: 7.514