Bleeding Complications After Surgical Aortic Valve Replacement Compared With Transcatheter Aortic Valve Replacement

被引：162

作者：

Genereux, Philippe ^{[1
,2
,3
]}

Cohen, David J. ^{[4
]}

Williams, Mathew R. ^{[1
]}

Mack, Michael ^{[5
]}

Kodali, Susheel K. ^{[1
,2
]}

Svensson, Lars G. ^{[6
]}

Kirtane, Ajay J. ^{[1
,2
]}

Xu, Ke ^{[2
]}

McAndrew, Thomas C. ^{[2
]}

Makkar, Raj ^{[7
]}

Smith, Craig R. ^{[1
]}

Leon, Martin B. ^{[1
,2
]}

机构：

[1] Columbia Univ, Med Ctr, New York Presbyterian Hosp, New York, NY 10032 USA

[2] Cardiovasc Res Fdn, New York, NY USA

[3] Hop Sacre Coeur, Montreal, PQ H4J 1C5, Canada

[4] St Lukes Mid Amer Heart Inst, Kansas City, MO USA

[5] Baylor Healthcare Syst, Plano, TX USA

[6] Cleveland Clin Fdn, Cleveland, OH 44195 USA

[7] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2014年 / 63卷 / 11期

关键词：

aortic stenosis; bleeding; surgical aortic valve replacement; transcatheter aortic valve implantation; transcatheter aortic valve replacement; ACADEMIC RESEARCH CONSORTIUM; END-POINT DEFINITIONS; HIGH-RISK PATIENTS; RED-BLOOD-CELL; VASCULAR COMPLICATIONS; CLINICAL-OUTCOMES; IMPLANTATION; STENOSIS; TRANSFUSION; PROSTHESIS;

D O I：

10.1016/j.jacc.2013.10.058

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives This study sought to identify the incidence, predictors, and prognostic impact of bleeding complications (BC) after surgical aortic valve replacement (SAVR) compared with transcatheter aortic valve replacement (TAVR). Background Bleeding complications after SAVR and TAVR are frequent and may be associated with an unfavorable prognosis. Methods In the randomized controlled PARTNER (Placement of Aortic Transcatheter Valve) I trial, 657 patients from cohort A (operable high risk) were randomly assigned to SAVR or TAVR (transfemoral [TF] if iliofemoral access was suitable or transapical [TA] if not) and received the designated treatment. First-generation Edwards SAPIEN valves and delivery systems (Edwards Lifesciences, Irvine, California) were used for TAVR, through a 22- or 24-F sheath. The 30-day rates of major BC (modified Valve Academic Research Consortium definitions), predictors of BC, and their association with 1-year mortality were assessed. Results A total of 71 (22.7%), 27 (11.3%), and 9 (8.8%) patients had major BC within 30 days of the procedure after SAVR, TF-TAVR, and TA-TAVR, respectively (p < 0.0001). SAVR was associated with a significantly higher 30-day rate of transfusion (17.9%) than either TF-TAVR (7.1%) or TA-TAVR (4.8%; p < 0.0001). Independent predictors of major BC were the occurrence of major vascular complications and use of intraprocedural hemodynamic support among TF-TAVR patients, severe procedural complications requiring conversion to open surgery among TA-TAVR patients, and the presence of low hemoglobin at baseline among SAVR patients. Major BC was identified as the strongest independent predictor of 1-year mortality among the full cohort. However, risk-adjusted analyses demonstrated a significant interaction between BC and treatment strategy with respect to mortality, suggesting that BC after SAVR have a greater impact on prognosis than after TAVR. Conclusions Among high-risk aortic stenosis patients enrolled in the PARTNER I randomized trial, BC were more common after SAVR than after TAVR and were also associated with a worse long-term prognosis. (C) 2014 by the American College of Cardiology Foundation

引用

页码：1100 / 1109

页数：10

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