Year: 2022
Type: article
Study design: Observational Study
Abstract: Data regarding the incidence, predictive factors, and clinical outcomes of post-transcatheter aortic valve replacement (TAVR) bleeding is limited in the Asian cohort. This study sought to assess the predictors and prognostic impact of post-TAVR late bleeding. This study used the Japanese multicenter registry data to analyze 2,518 patients (mean age: 84.3 ± 5.2 years) who underwent TAVR. Late bleeding was defined as any postdischarge bleeding events after TAVR. Baseline characteristics, predictive factors, and clinical outcomes including death and rehospitalization were assessed in patients with and without late bleeding events. The cumulative incidence rate of all and major late bleeding and ischemic stroke were 7.4%, 5.2%, and 3.4%, respectively, 3 years after TAVR. The independent predictive factors of late bleeding were low platelet count, high score (≥4) on the clinical frailty scale, and a New York Heart Association functional class III/IV. The cumulative mortality rates up to 3 years were significantly higher in patients with late bleeding than in those without bleeding (P < 0.001). The multivariate Cox regression analysis revealed that late bleeding, included as a time-varying covariate in the model, was associated with an increased risk of mortality following TAVR (HR: 5.63; 95% CI: 4.28-7.41; P < 0.001). Late bleeding after TAVR was not a rare complication, and it significantly increased long-term mortality. It should be carefully managed, especially when it is predictable in the high-risk cohort, and efforts should be taken to reduce bleeding complications even after a successful procedure.
Source: JACC Asia
Authors: Masanori Yamamoto, Toshiaki Otsuka, Tetsuro Shimura, Ryo Yamaguchi, Yuya Adachi, Ai Kagase, Takahiro Tokuda, Satoshi Tsujimoto, Yutaka Koyama, Fumiaki Yashima, Norio Tada, Toru Naganuma, Masahiro Yamawaki, Futoshi Yamanaka, Shinichi Shirai, Kazuki Mizutani, Minoru Tabata, Hiroshi Ueno, Kensuke Takagi, Yusuke Watanabe, Kentaro Hayashida
Institutions: Toyohashi Heart Center, Nagoya Heart Center, Nippon Medical School Hospital, Nippon Medical School, Keio University, Saiseikai Utsunomiya hospital, Sendai Kousei Hospital, New Tokyo Hospital, Saiseikai Yokohama Eastern Hospital, Shonan Kamakura General Hospital, Kokura Memorial Hospital, Kindai University, Tokyo Bay Urayasu Ichikawa Medical Center, Toyama University Hospital, University of Toyama, Ogaki Municipal Hospital, Teikyo University
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,500
OpenAlex ID: W4294816616