title: Incidence and risk factors of hemolysis after transcatheter aortic valve implantation with a balloon-expandable valve.
abstract: There are currently no data evaluating the hematologic and biocompatibility profile of transcatheter aortic valves in vivo. We evaluated the incidence, predictive factors, and clinical consequences associated with hemolysis post-transcatheter aortic valve implantation (TAVI). A total of 122 patients who underwent TAVI with a balloon-expandable valve were included. Baseline blood sampling and echocardiography, followed by early post-TAVI echocardiography and repeat blood sampling, at 6 to 12 months post-TAVI were performed. Hemolysis post-TAVI was defined according to the established criteria. The incidence of hemolysis post-TAVI was 14.8% yet no patient experienced severe hemolytic anemia requiring transfusion. Compared with the nonhemolysis group, those with hemolysis demonstrated significant reductions in hemoglobin (p = 0.012), were more frequently women (67% vs 34%, p = 0.016), and had a higher incidence of post-TAVI severe prosthesis-patient mismatch (PPM) (44% vs 17%, p = 0.026). The rate of mild or more prosthetic valve regurgitation did not significantly differ between those patients with and without hemolysis (56% vs 37%, p = 0.44). Wall shear rate (WSR) and energy loss index (ELI), both indirect measures of shear stress, were higher (p = 0.039) and lower (p = 0.004), respectively, in those patients with hemolysis. Increasing PPM severity was also associated with significant stepwise WSR increments and ELI decrements (p <0.01 for both). In conclusion, subclinical hemolysis occurred in 15% of patients following TAVI. Although prosthetic valve regurgitation had no impact on hemolysis, a novel association between PPM and hemolysis was found, likely driven by higher shear stress as determined by WSR and ELI. These hematologic and biomechanical findings may have long-term clinical implications and could affect future transcatheter aortic valve design.
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Jérôme
authors: J
authors: Laflamme
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Rishi
authors: R
authors: Puri
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Marina
authors: M
authors: Urena
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Louis
authors: L
authors: Laflamme
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Hugo
authors: H
authors: DeLarochellière
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Omar
authors: O
authors: Abdul-Jawad Altisent
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Maria
authors: M
authors: del Trigo
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Francisco
authors: F
authors: Campelo-Parada
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Robert
authors: R
authors: DeLarochellière
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Jean-Michel
authors: JM
authors: Paradis
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Eric
authors: E
authors: Dumont
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Daniel
authors: D
authors: Doyle
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Siamak
authors: S
authors: Mohammadi
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Mélanie
authors: M
authors: Côté
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Philippe
authors: P
authors: Pibarot
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Vinçent
authors: V
authors: Laroche
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address: josep.rodes@criucpq.ulaval.ca.
authors: Josep
authors: J
authors: Rodés-Cabau
mesh_terms: D000368:Aged; D000743:Anemia, Hemolytic / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006350:Heart Valve Prosthesis; D006461:Hemolysis; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D011474:Prosthesis Design; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*