Impact on prognosis of periprocedural bleeding after TAVI: mid-term follow-up of a multicenter prospective study.
OBJECTIVE
Impact of periprocedural bleeding after transcatheter aortic valve implantation (TAVI) over mid-term prognosis remains still unclear.


METHODS
Consecutive patients who underwent TAVI from May 2008 to July 2012 were prospectively included and stratified according to life-threatening (LT) and major bleeding (MB). Mid-term all-cause death was the primary end-point, and 30-day death, vascular complications, stroke, and acute kidney injury the secondary ones. All end-points were adjudicated according to VARC.


RESULTS
Seven hundred fourteen patients with an average age of 81.9 ± 5.8 years were included. 130 (18%) patients suffered a LT, 112 (16%) a MB. A preprocedural GFR <30 ml/min and increasing diameter of sheaths were independent predictors of LT or MB, while transfemoral approach showed a protective effect (OR 0.42; CI: 0.26-0.68; P = 0.035). At 30 days LT (OR 3.3; CI: 1.1-9.7; P = 0.0026) and MB (OR 3.5; CI: 1.4-8.6; P = 0.007) bleeding along with GFR < 30 ml/min (OR 2.3; CI: 1.1-5.5; P = 0.04) were independent predictors of death, while bleeding did not impact survival on mid term (OR 0.9; CI: 0.47-1.7; P = 0.78; all CI 95%).


CONCLUSIONS
Periprocedural bleeding after TAVI was frequent and associated with an increased mortality after 30 days but not after mid-term follow-up. A preprocedural GFR < 30 ml/min was the most important predictor of bleeding, enabling risk stratification and choice of approach for these patients.
Division of Cardiology 1, Department of Internal Medicine, Città Della Salute e Della Scienza, Turin, Italy; Division of Cardiology 2, Department of Internal Medicine, Città della Salute e della Scienza Hospital, Turin, Italy.
Claudio
C
Moretti
Maurizio
M
D'Amico
Fabrizio
F
D'Ascenzo
Chiara
C
Colaci
Stefano
S
Salizzoni
Corrado
C
Tamburino
Patrizia
P
Presbitero
Sebastiano
S
Marra
Imad
I
Sheiban
Fiorenzo
F
Gaita
D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000503:physiopathology / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000379:methods