Valvular Heart Disease
Meta-analysis of Predictors of Early Severe Bleeding in Patients Who Underwent Transcatheter Aortic Valve Implantation

https://doi.org/10.1016/j.amjcard.2017.05.035Get rights and content

Severe bleeding (SB) in patients who underwent transcatheter aortic valve implantation (TAVI) could be fatal. Although multiple independent predictors of bleeding post-TAVI have been identified, the definitions of bleeding and predictors vary across studies. This study aimed to provide summary effect estimates for predictors of SB within 30 days post-TAVI. A systematic review of studies that reported the incidence of bleeding post-TAVI with raw data for predictors of interest was performed. Data on characteristics of study, patient, and procedure were extracted. Crude risk ratios (RRs) and 95% confidence intervals were calculated using random-effect model. Fifteen predictors on 65,209 patients from 47 studies were analyzed. The median rate of SB was 11% across studies. Seven factors (3 patient related and 4 procedure related) were recognized as predictors of early SB post-TAVI. Age ≥90 years (RR 1.17; p = 0.008), female (RR 1.13; p = 0.01), and sheath diameter >19 Fr (RR 1.19; p = 0.04) were weak predictors. Chronic kidney disease (RR 1.94; p <0.001) and transapical (TA) (RR 1.82; p <0.001) were moderate predictors that were almost associated with twofold risk. Vascular complication (RR 2.97; p <0.001) and circulatory support (RR 3.39; p <0.001) were strong predictors that were nearly associated with threefold risk. In conclusion, age, gender, chronic kidney disease, TA, sheath diameter, vascular complication, and circulatory support were all predictors of early SB post-TAVI in this meta-analysis, which provided possible guidance for prevention and management of SB related to TAVI.

Section snippets

Methods

A systematic review of published data on bleeding in patients who underwent TAVI was performed according to recommendation of PRISMA.11 A computerized search was conducted to identify all relevant studies from PubMed and Web of Science databases. The detailed search strategies are shown in the Supplementary Data.

Any study that reported the incidence of SB post-TAVI between 2 groups of patients divided according to the presence/absence of a potential predictor with a sample size >50 were deemed

Results

The PRISMA flow chart was showed in Figure 1. A total of 4,256 records were screened at the title and abstract level, of which 616 full-text articles were retrieved and assessed for eligibility. Finally, 47 studies were deemed eligible for the analysis according to the inclusion and exclusion criteria.

General characteristics of included studies were listed in Table 1. Overall, 65,209 patients were evaluated, with 6,411 patients experienced early SB post-TAVI. The median rate of SB was 11%

Discussion

Lately, 1 meta-analysis of risk factors for post-TAVI bleeding has just been published.23 It focused on any VARC-2 bleeding; however, minor bleeding was less important and may affect the result greatly. Also, factors being evaluated were not comprehensive. Moreover, studies and patients included were quite limited. In contrast, the present study that focused on fatal SB was more comprehensive with much larger population. Our results suggested that 3 patient-related factors (age ≥90, female

Disclosures

The authors have no conflicts of interest to disclose.

References (30)

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Drs Sun and Liu contributed equally to the manuscript.

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