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Bleeding linked to mortality in TAVR
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New data have linked access-site and non-access-site bleeding after transcatheter aortic valve replacement to increased mortality, with risk being particularly high with non-access-site bleeding.
“Although TAVR has been consistently associated with lower rates of bleeding events than conventional surgery, the differential prognostic impact of access-site and non-access-site bleeding in the setting of TAVR is unknown,” the researchers wrote.
To determine whether the location of bleeding affects outcomes after TAVR, the researchers evaluated data from patients undergoing TAVR from 2007 to 2014 in the Bern TAVR Registry, which is part of the Swiss TAVR Registry. Bleeding events were defined using the Valve Academic Research Consortium (VARC)-2 criteria.
Among 926 patients (mean age, 82 years; 53% women) included in the analysis, 30.7% experienced at least one minor, major or life-threatening bleeding event up to 5 years, with 51% experiencing access-site bleeding and 49% experiencing non-access-site bleeding. Nearly 25% experienced life-threatening or major bleeding, which represented most bleeding events (78.6%). The most common site of non-access-site bleeding was the gastrointestinal tract, the researchers noted.
Results found an increased adjusted risk for all-cause mortality among patients with access-site (HR = 1.34; 95% CI, 1.01-1.76) and non-access-site bleeding (HR = 2.08; 95% CI, 1.6-2.71), as compared with patients without a bleeding event.
When compared with access-site bleeding, however, adjusted risk for all-cause mortality was significantly higher with non-access-site bleeding (HR = 1.56; 95% CI, 1.12-2.18), according to the data.
In multivariate analysis, the researchers identified female sex as a significant correlate of access-site bleeding and chronic kidney disease and Society of Thoracic Surgeons score as significant correlates of non-access-site bleeding.
Among patients who underwent transfemoral TAVR (n = 746), results were generally consistent with the overall findings. Among patients who underwent transapical TAVR (n = 165), there was no difference in mortality risk associated with access-site vs. non-access-site bleeding (adjusted HR = 1.23; 95% CI, 0.48-3.14), but the researchers noted the analysis was likely underpowered due to the small number of patients in the transapical cohort.
“Future studies focused on preventive strategies for either form of bleeding are warranted and might have important clinical implications in the care of patients with severe aortic stenosis undergoing TAVR,” the researchers wrote. – by Melissa Foster
Disclosures: Piccolo reports receiving a research grant from the Veronesi Foundation, outside the submitted work. Please see the study for all other authors’ relevant financial disclosures.
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