Purpose: This work, aims to examine the incidence, associated with clinical and procedural factors, and the impact of peri-procedural bleeding during TAVI, in short and medium-term prognosis. Methods: It is a multicentre and prospective study, which considers all consecutive patients who underwent TAVI from May 2008 to July 2012 at our centers. The serious bleeding, divided into life-threatening (LT) or mayor (MB) groups, are classified according to Varc document. The primary end point regards all-cause mortality after 30 days or at medium-term (mean 400 days) while, the secondary end points are cardiovascular death after 30 days or at medium term. Results: The study have included 714 patients with a severe aortic valvular stenosis (average aortic valve area: 0.66±0.6 cm2) and a mean age of 81.97±5.8 years; besides many of these patients have showed a reduction of glomerular filtration rate (19.9%: GFR<30ml/min-46.1%:GFR<60ml/min). Peri-procedural haemorrhages, are reported in 242 patients (LT=130 MB=112) and 44 people have presented a minor bleeding. At 30 days, all-cause mortality was significantly higher in patients with LT and MB bleedings than in those without this complication (13.10% vs 8.90% vs 4.8% p 0.003), and equally after 400 days (37.4% vs 27.2% vs 17.3%; p<0.0001). The results are strengthened for cardiovascular death that was significantly elevated in patients who have presented serious haemorrhages at short and medium term (21.10% vs 10% vs 4.6%; p<0.0001-20.5% vs 13.5% vs 5.9%; p<0.0001).At 30 days life-threatening (OR 3.3 CI 1.1-9.7 p 0.0026) and major (OR 3.5;CI 1.4-8.6 p 0.007) haemorrhages, along with GFR<30ml/min (OR 2.3 CI; 1.1-5.5 p 0.04), are showed as independent predictors of death, while at mid-term only impaired renal function is remained a significant predictor of mortality (OR 2.3:CI 1.1-3.9; p 0.01).Moreover, GFR<30ml/min (OR 1.6: CI 1.1-2.7; p 0.04) and prosthetic valvular diameter greater than 23 mm (26mm p 0.05; 29mm; p 0.04; 31mm p 0.09) are indicated as independent predictors of LT or MB bleedings, while transfemoral approach is appeared a protective factor (OR 0.42: CI 0.26-0.68; p 0.035). Conclusions: Periprocedural bleedings during TAVI are common and they relates to an increased mortality after 30 days but not after mid-term follow up. Trans-femoral approach appears protective, while impaired renal function is the principal predictor of bleeding, thus allowing risk stratification and the selection of approach for these patients.

A mid-term follow-up of a multicentre prospective study about life-threatening and major bleedings after TAVI

D'ASCENZO, FABRIZIO;SALIZZONI, STEFANO;GAITA, Fiorenzo
2013

Abstract

Purpose: This work, aims to examine the incidence, associated with clinical and procedural factors, and the impact of peri-procedural bleeding during TAVI, in short and medium-term prognosis. Methods: It is a multicentre and prospective study, which considers all consecutive patients who underwent TAVI from May 2008 to July 2012 at our centers. The serious bleeding, divided into life-threatening (LT) or mayor (MB) groups, are classified according to Varc document. The primary end point regards all-cause mortality after 30 days or at medium-term (mean 400 days) while, the secondary end points are cardiovascular death after 30 days or at medium term. Results: The study have included 714 patients with a severe aortic valvular stenosis (average aortic valve area: 0.66±0.6 cm2) and a mean age of 81.97±5.8 years; besides many of these patients have showed a reduction of glomerular filtration rate (19.9%: GFR<30ml/min-46.1%:GFR<60ml/min). Peri-procedural haemorrhages, are reported in 242 patients (LT=130 MB=112) and 44 people have presented a minor bleeding. At 30 days, all-cause mortality was significantly higher in patients with LT and MB bleedings than in those without this complication (13.10% vs 8.90% vs 4.8% p 0.003), and equally after 400 days (37.4% vs 27.2% vs 17.3%; p<0.0001). The results are strengthened for cardiovascular death that was significantly elevated in patients who have presented serious haemorrhages at short and medium term (21.10% vs 10% vs 4.6%; p<0.0001-20.5% vs 13.5% vs 5.9%; p<0.0001).At 30 days life-threatening (OR 3.3 CI 1.1-9.7 p 0.0026) and major (OR 3.5;CI 1.4-8.6 p 0.007) haemorrhages, along with GFR<30ml/min (OR 2.3 CI; 1.1-5.5 p 0.04), are showed as independent predictors of death, while at mid-term only impaired renal function is remained a significant predictor of mortality (OR 2.3:CI 1.1-3.9; p 0.01).Moreover, GFR<30ml/min (OR 1.6: CI 1.1-2.7; p 0.04) and prosthetic valvular diameter greater than 23 mm (26mm p 0.05; 29mm; p 0.04; 31mm p 0.09) are indicated as independent predictors of LT or MB bleedings, while transfemoral approach is appeared a protective factor (OR 0.42: CI 0.26-0.68; p 0.035). Conclusions: Periprocedural bleedings during TAVI are common and they relates to an increased mortality after 30 days but not after mid-term follow up. Trans-femoral approach appears protective, while impaired renal function is the principal predictor of bleeding, thus allowing risk stratification and the selection of approach for these patients.
Esc Congress 2013
Amsterdam
31/08/2013-04/09/2013
34 ( Abstract Supplement )
994
994
http://spo.escardio.org/abstract-book/presentation.aspx?id=120128
C. Moretti; C. Colaci; F. D'Ascenzo; S. Salizzoni; M. La Torre; M. Barbanti; I. Sheiban; C. Tamburino; S. Marra; F. Gaita
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/158456
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus ND
  • ???jsp.display-item.citation.isi??? ND
social impact