title: Blood oozing: A cause of life-threatening bleeding without overt source after transcatheter aortic valve replacement.
abstract: BACKGROUND
  Post-procedure non-access site-related bleedings have a significant impact on mortality in patients treated by transcatheter aortic valve replacement (TAVR). Notwithstanding, the source of these bleedings is frequently indeterminate, with potentially serious clinical implications related to lack of diagnosis and treatment.
  
  
  METHODS
  Out of 513 TAVR performed between June 2007 and January 2016 in the Interventional Cardiology Laboratory of the Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, we identified few proven cases of concealed bleeding after TAVR due to blood oozing.
  
  
  RESULTS
  We report three cases of angiographically confirmed post-TAVR non-access bleedings related to spontaneous blood oozing, a life-threatening condition consisting of diffuse capillary hemorrhage developing from vessels not directly involved by the procedure. We hypothesize that spontaneous post-procedural blood oozing may account for a substantial proportion of non-overt, non-access site-related bleeding after TAVR.
  
  
  CONCLUSIONS
  The possibility of post-TAVR blood oozing is largely neglected in the literature, and comprehensive categorization of non-access site bleedings in current standardized endpoints of TAVR studies is missing. Early assessment with arterial and venous contrast phase angio-MDCT scans in case of post-TAVR unexplained and persistent anemia may allow diagnosis and treatment of this subtle condition.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, Padua, Italy. Electronic address: giuseppe.tarantini.1@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, Padua, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Mojoli
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, Padua, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Barioli
authors.affiliation: University Radiology, Department of Medicine, University Hospital of Padua, Padua, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Battistel
authors.affiliation: New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA; Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY, USA; Hopital du Sacre-Coeur de Montreal, Université de Montreal, Montreal, QC, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
mesh_terms: D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D002196:Capillaries / Q000000981:diagnostic imaging / Q000503:physiopathology; D000072226:Computed Tomography Angiography / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D019990:Perioperative Care / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D012187:Retroperitoneal Space / Q000000981:diagnostic imaging; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin
keywords: Interventional cardiology; Non-access site bleeding; Transcatheter aortic valve replacement