Usefulness of Periprocedural Bleeding to Predict Outcome After Transcatheter Aortic Valve Implantation

Bleeding is a known predictor of poor outcome after a number of cardiac interventions. We investigated whether using the new bleeding definition of the Valve Academic Research Consortium predicts a poor outcome after transcatheter aortic valve implantation. In addition, we sought to identify those patient characteristics that predict periprocedural bleeding and investigated the effect of blood transfusion. This was a retrospective study of 101 patients undergoing transapical or transfemoral transcatheter aortic valve implantation at Kings College Hospital from August 2007 to November 2010. The association among bleeding, blood transfusion, and in-hospital and 6-month mortality was examined. Of the 101 patients, 5 (4.9%) had life-threatening periprocedural bleeding related to vascular or apical complications, 17 (17%) had major bleeding, and 79 (78%) had minor or no bleeding. The in-hospital mortality rate for the cohort was 9.9% (n = 10) and the 6-month mortality rate was 18.8% (n = 19). Those patients with life-threatening bleeding and those who were transfused had significantly greater in-hospital mortality rates than the patients without life-threatening bleeding or transfusion (60.0% vs 7.3%, p <0.05; and 14.8% vs 4.3%, p <0.05, respectively). Life-threatening bleeding, a decrease in hemoglobin >5 g/dl, and a blood transfusion of >2 U were associated with increased mortality at 6 months. In a logistic regression model, coexisting vascular disease, diabetes, and preprocedural anemia significantly affected the incidence of life-threatening or major bleeding. In conclusion, consistent with many other cardiac interventions, life-threatening periprocedural bleeding after transcatheter aortic valve implantation is associated with poorer outcomes.