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Bleeding after Transcatheter Aortic Valve Implantation – what are the outcomes and how can we predict it
Session:
Posters (Sessão 5 - Écran 7) - Intervenção Cardíaca Coronária e Estrutural 3 - Foco na Válvula Aórtica
Speaker:
Alexandra Castelo
Congress:
CPC 2022
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Alexandra Castelo; André Grazina; Tiago Mendonça; Inês Rodrigues; Vera Ferreira; Pedro Brás; Sofia Jacinto; António Fiarresga; Ruben Ramos; Duarte Cacela; Rui Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><u>Background</u>: Bleeding is a known complication after transcatheter aortic valve implantation (TAVI), but there is a paucity of information about bleeding predictors and related outcomes.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><u>Purpose</u>: To identify post-TAVI bleeding predictors and evaluate related outcomes.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><u>Methods</u>: Retrospective analysis of consecutive patients (P) submitted to TAVI between 2009 and 2020 in a tertiary center. Baseline characteristics, procedural information, bleeding after TAVI and outcomes were collected. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><u>Results</u>: </span>A total of 517P (56.3% female) were included, with a mean age of 82 ± 6years. 112<span style="color:black">P (21.6%) had a hemorrhagic complication after the procedure (10% minor, 5.8% major and 5.8% life-threatening, according to VARC 2 classification). Patients with serious bleeding (major or life-threatening) had more global, intra-hospital and 30 day mortality (45.8% vs 23.1%, p<0.0001; 28.3% vs 2.6%, p<0.0001; 28.3% vs 3.7%, p<0.0001), global and 30 day cardiovascular mortality (32.2% vs 7.3%, p<0.0001 and 28.3% vs 2.2%, p<0.0001), higher global hospital stay (24 days vs 15 days, p<0.0001), intensive care unit stay (7 days vs 4 days, p = 0.001) and post TAVI hospital stay (18 days vs 10 days, p<0.0001), lower minimum hemoglobin level (7.7 g/L vs 9.9 g/L, p<0.0001) and higher maximum creatinine level (2.4 mg/dL vs 1.6 mg/dL, p<0.0001) and were more frequently in NYHA class III or IV at 30 days (11.4% vs 3.8%, p<0.0001). When other predictors of these outcomes are included in multivariable analysis, serious bleeding is still an independent predictor of intra-hospital and 30 days mortality (p = 0.004 and p = 0.014), global and 30 days cardiovascular mortality (p<0.0001 and p = 0.001), post TAVI hospital stay (p = 0.002), minimum hemoglobin level (p<0.0001) and 30 days NYHA III or IV (p = 0.018). Considering baseline characteristics, patients with serious bleeding had worse vascular accesses (24% vs 8.3%, p<0.0001), more frequently previous coronary angioplasty (33.3% vs 20.2%, p = 0.021), peripheral artery disease (25% vs 14.9%, p = 0.046), chronic kidney disease (65% vs 48.7%, p = 0.017) and higher STS score (7.4% vs 5.8%, p = 0.013). They also had more frequently major vascular complications (40% vs 1.3%, p<0.0001). There were no differences according to transfemoral vs non transfemoral route (11.5% vs 11.1%, p = 0.943). In a multivariable analysis, considering these differences, worse vascular accesses (p = 0.049, OR = 2.68), chronic kidney disease (p = 0.007, OR = 3.14) and major vascular complication (p<0.0001, OR = 73.96) were the independent predictors.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><u>Conclusion</u>: Hemorrhage is a relatively common complication after TAVI, and when serious is associated with a significant worst prognosis. There are some clinical characteristics that are associated with a higher risk which should be considered when treating these patients, for an earlier detection in case of its occurrence.</span></span></span></p>
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