Structural
Frequency, Timing, and Impact of Access-Site and Non–Access-Site Bleeding on Mortality Among Patients Undergoing Transcatheter Aortic Valve Replacement

https://doi.org/10.1016/j.jcin.2017.04.034Get rights and content
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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.

Key Words

access-site bleeding
aortic stenosis
bleeding
non–access-site bleeding
TAVR

Abbreviations and Acronyms

CI
confidence interval
HR
hazard ratio
PRBC
packed red blood cell
SAVR
surgical aortic valve replacement
STS
Society of Thoracic Surgeons
TAVR
transcatheter aortic valve replacement

Cited by (0)

Dr. Piccolo has received a research grant from the Veronesi Foundation, outside the submitted work. Dr. Pilgrim has received research grants from Edwards Lifesciences and Symetis; and reimbursement of travel costs from Biotronik and Edwards Lifesciences. Dr. Valgimigli has received personal fees for serving on the advisory boards of AstraZeneca and St. Jude Vascular; and lecture fees from AstraZeneca, Terumo Medical, Alvimedica, St. Jude Vascular, Abbott Vascular, The Medicines Company, and Correvio, outside the submitted work. Dr. Windecker has received grants to his institution from Abbott Vascular, Biotronik, Boston Scientific, Medtronic, Edwards Lifesciences, and St. Jude Medical, outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.