Author + information
- Rafath Ullah1,
- Mubeen Khan Mohammed Abdul2,
- Maharaj Singh3,
- Puneet Menaria1,
- Amanda Kirby2,
- Suhail Q. Allaqaband4,
- Daniel P. O'Hair4,
- Tanvir Bajwa4 and
- Tonga Nfor4
- 1Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, United States
- 2Aurora St Luke's Medical Center, Milwaukee, Wisconsin, United States
- 3Aurora Research Institute, Milwaukee, Wisconsin, United States
- 4Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin, United States
Severe aortic stenosis causes recurrent mucosal bleeds, mainly from angiodysplasias and acquired von Willebrand deficiency (vWD) which is corrected after aortic valve replacement, either transcatheter (TAVR) or surgical (SAVR). Studies have shown major GI bleeding post-TAVR as an independent predictor of mortality. It is unknown if patients with GI bleed pre-TAVR are at increased risk as well.
A comprehensive retrospective analysis was done of 661 TAVR patients at a large tertiary care center. Each patient was screened for major GI bleeds 1-year prior to valve replacement.
Out of 661 patients undergoing TAVR, 68 (10.3%) were found to have GI bleed prior to valve replacement. Occurrence of GI bleed pre-TAVR was significantly associated with mortality following valve replacement in patients who had coronary artery disease (CAD) but not in those without CAD (table). After propensity matching, there were 68 patients in GI bleed and non-GI bleed groups each, with median follow-up 15 months. All-cause survival was significantly worse in patients with GI bleed pre-TAVR compared to no bleed (figure).
|Mortality, n (%)||Alive, n(%)|
|CAD||GI bleed||20 (43.5%)||26 (56.5%)||p value 0.0346|
|No GI bleed||49 (27.4%)||130 (72.6%)|
|No CAD||GI bleed||5 (22.7%)||17 (77.3%)||p value 0.4834|
|No GI bleed||123 (29.7%)||291 (70.3%)|
GI bleed prior to TAVR is an independent predictor of mortality and needs to be included in the risk evaluation process prior to valve replacement.
STRUCTURAL: Valvular Disease: Aortic