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Impact of Transcatheter Aortic Valve Implantation on Severe Gastrointestinal Bleeding in Patients With Aortic Stenosis

      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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      References

        • Heyde EC.
        Gastrointestinal bleeding in aortic stenosis.
        N Engl J Med. 1958; 259: 196
        • King RM
        • Pluth JR
        • Giuliani ER.
        The association of unexplained gastrointestinal bleeding with calcific aortic stenosis.
        Ann Thorac Surg. 1987; 44: 514-516
        • Mondal S
        • Hollander KN
        • Ibekwe SO
        • Williams B
        • Tanaka K.
        Heyde syndrome-pathophysiology and perioperative implications.
        J Cardiothorac Vasc Anesth. 2021; 35: 3331-3339
        • Vincentelli A
        • Susen S
        • Le Tourneau T
        • Six I
        • Fabre O
        • Juthier F
        • Bauters A
        • Decoene C
        • Goudemand J
        • Prat A
        • Jude B
        Acquired von Willebrand syndrome in aortic stenosis.
        N Engl J Med. 2003; 349: 343-349
        • Pareti FI
        • Lattuada A
        • Bressi C
        • Zanobini M
        • Sala A
        • Steffan A
        • Ruggeri ZM.
        Proteolysis of von Willebrand factor and shear stress-induced platelet aggregation in patients with aortic valve stenosis.
        Circulation. 2000; 102: 1290-1295
        • Veyradier A
        • Balian A
        • Wolf M
        • Giraud V
        • Montembault S
        • Obert B
        • Dagher I
        • Chaput JC
        • Meyer D
        • Naveau S
        Abnormal von Willebrand factor in bleeding angiodysplasias of the digestive tract.
        Gastroenterology. 2001; 120: 346-353
        • Horiuchi H
        • Doman T
        • Kokame K
        • Saiki Y
        • Matsumoto M.
        Acquired von Willebrand syndrome associated with cardiovascular diseases.
        J Atheroscler Thromb. 2019; 26: 303-314
        • Sami SS
        • Al-Araji SA
        • Ragunath K.
        Review article: gastrointestinal angiodysplasia—pathogenesis, diagnosis and management.
        Aliment Pharmacol Ther. 2014; 39: 15-34
        • Warkentin TE
        • Moore JC
        • Anand SS
        • Lonn EM
        • Morgan DG.
        Gastrointestinal bleeding, angiodysplasia, cardiovascular disease, and acquired von Willebrand syndrome.
        Transfus Med Rev. 2003; 17: 272-286
        • Draper KV
        • Huang RJ
        • Gerson LB.
        GI bleeding in patients with continuous-flow left ventricular assist devices: a systematic review and meta-analysis.
        Gastrointest Endosc. 2014; 80 (435–446.e1)
        • Thompson JL
        • Schaff HV
        • Dearani JA
        • Park SJ
        • Sundt TM 3rd
        • Suri RM
        • Blackshear JL
        • Daly RC
        Risk of recurrent gastrointestinal bleeding after aortic valve replacement in patients with Heyde syndrome.
        J Thorac Cardiovasc Surg. 2012; 144: 112-116
        • Benton SM Jr
        • Kumar A
        • Crenshaw M
        • Fredi JL.
        Effect of transcutaneous aortic valve implantation on the Heyde's syndrome.
        Am J Cardiol. 2014; 114: 953-954
        • Love JW.
        The syndrome of calcific aortic stenosis and gastrointestinal bleeding: resolution following aortic valve replacement.
        J Thorac Cardiovasc Surg. 1982; 83: 779-783
        • Pate GE
        • Chandavimol M
        • Naiman SC
        • Webb JG.
        Heyde's syndrome: a review.
        J Heart Valve Dis. 2004; 13: 701-712
        • Undas A
        • Natorska J.
        Bleeding in patients with severe aortic stenosis in the era of transcatheter aortic valve replacement.
        JACC Cardiovasc Interv. 2015; 8: 701-703
        • Desai R
        • Parekh T
        • Singh S
        • Patel U
        • Fong HK
        • Zalavadia D
        • Savani S
        • Doshi R
        • Sachdeva R
        • Kumar G.
        Alarming increasing trends in hospitalizations and mortality with Heyde's Syndrome: a nationwide inpatient perspective (2007 to 2014).
        Am J Cardiol. 2019; 123: 1149-1155
        • Spangenberg T
        • Budde U
        • Schewel D
        • Frerker C
        • Thielsen T
        • Kuck KH
        • Schäfer U.
        Treatment of acquired von Willebrand syndrome in aortic stenosis with transcatheter aortic valve replacement.
        JACC Cardiovasc Interv. 2015; 8: 692-700
        • Waldschmidt L
        • Drolz A
        • Heimburg P
        • Goßling A
        • Ludwig S
        • Voigtländer L
        • Linder M
        • Schofer N
        • Reichenspurner H
        • Blankenberg S
        • Westermann D
        • Conradi L
        • Kluwe J
        • Seiffert M.
        Heyde syndrome: prevalence and outcomes in patients undergoing transcatheter aortic valve implantation.
        Clin Res Cardiol. 2021; 110: 1939-1946
        • Sedaghat A
        • Kulka H
        • Sinning JM
        • Falkenberg N
        • Driesen J
        • Preisler B
        • Hammerstingl C
        • Nickenig G
        • Pötzsch B
        • Oldenburg J
        • Hertfelder HJ
        • Werner N.
        Transcatheter aortic valve implantation leads to a restoration of von Willebrand factor (VWF) abnormalities in patients with severe aortic stenosis - incidence and relevance of clinical and subclinical VWF dysfunction in patients undergoing transfemoral TAVI.
        Thromb Res. 2017; 151: 23-28
        • Godino C
        • Lauretta L
        • Pavon AG
        • Mangieri A
        • Viani G
        • Chieffo A
        • Galaverna S
        • Latib A
        • Montorfano M
        • Cappelletti A
        • Maisano F
        • Alfieri O
        • Margonato A
        • Colombo A.
        Heyde's syndrome incidence and outcome in patients undergoing transcatheter aortic valve implantation.
        J Am Coll Cardiol. 2013; 61: 687-689
        • Cardounel AJ
        • Gleason TG
        • Lee JS
        • Schindler JT
        • Kliner D
        • Navid F
        • Bianco V
        • Sultan I.
        Surgical cut down for vascular access with conscious sedation for transcatheter aortic valve replacement: the best of both worlds?.
        Interact Cardiovasc Thorac Surg. 2018; 27: 494-497
        • Bianco V
        • Kilic A
        • Gleason TG
        • Lee JS
        • Schindler J
        • Aranda-Michel E
        • Wang Y
        • Navid F
        • Kliner D
        • Cavalcante JL
        • Mulukutla SR
        • Sultan I.
        Long-term hospital readmissions after surgical vs transcatheter aortic valve replacement.
        Ann Thorac Surg. 2019; 108: 1146-1152
        • Habertheuer A
        • Gleason TG
        • Kilic A
        • Schindler J
        • Kliner D
        • Bianco V
        • Toma C
        • Aranda-Michel E
        • Kacin A
        • Sultan I.
        Impact of perioperative stroke on midterm outcomes after transcatheter aortic valve replacement.
        Ann Thorac Surg. 2020; 110: 1294-1301
        • Habertheuer A
        • Aranda-Michel E
        • Schindler J
        • Gleason TG
        • Kilic A
        • Kliner D
        • Bianco V
        • Toma C
        • Sultan I.
        Longitudinal outcomes of nonagenarians undergoing transcatheter aortic valve replacement.
        Ann Thorac Surg. 2021; 111: 1520-1528
        • Sultan I
        • Fukui M
        • Bianco V
        • Brown JA
        • Kliner DE
        • Hickey G
        • Thoma FW
        • Lee JS
        • Schindler JT
        • Kilic A
        • Gleason TG
        • Cavalcante JL.
        Impact of combined pre and postcapillary pulmonary hypertension on survival after transcatheter aortic valve implantation.
        Am J Cardiol. 2020; 131: 60-66