To investigate the effectiveness of transcatheter aortic valve implantation (TAVI)
for resolving gastrointestinal bleeding (GIB) in patients with severe GIB and severe
aortic stenosis. This was an observational study of consecutive TAVI procedures from
2011 to 2018, identified through a prospectively maintained institutional database.
Patients with severe GIB defined as abnormal hemoglobin/hematocrit and overt bleeding
or positive fecal occult blood test. Groups were compared for differences in baseline
clinical and procedural characteristics and post-TAVI outcomes. A total of 1,192 patients
who underwent TAVI were identified, of which 164 patients (13.8%) were found to have
had severe GIB. Society of Thoracic Surgeons-Predicted Risk of Mortality scores were
higher in the severe GIB group than in the non-GIB group (8.8 ± 5.3 vs 7.6 ± 4.5,
p = 0.002). The 30-day mortality was similar across each group (p >0.05), with overall
30-day mortality being 3.2% (38 of 1,192) for the entire cohort. Of the 164 TAVIs
with severe GIB, 130 (79.3%) had resolution of their GIB after their TAVI. Patients
without resolution of their GIB had higher aortic valve mean pressure gradients after
their TAVI (15.0 ± 5.3 vs 9.0 ± 4.3). In conclusion, TAVI was associated with substantial
reductions in severe GIB. Despite higher baseline risk, patients with severe GIB achieved
similar outcomes, including 30-day mortality, compared with patients without GIB.
TAVI may be a safe and effective treatment for patients with severe aortic stenosis
and severe GIB, whereas persistently high transvalvular pressure gradients after TAVI
may be related to the likelihood of recurrent GIB.
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Article Info
Publication History
Published online: June 28, 2022
Received in revised form:
April 19,
2022
Received:
January 31,
2022
Footnotes
Drs. Brown and Sultan contributed equally to this manuscript.
Identification
Copyright
© 2022 Published by Elsevier Inc.
