Background

Heyde syndrome (HS) is known as the association of severe aortic stenosis (AS) and recurrent gastrointestinal bleeding (GIB) from angiodysplasia. Data on the prevalence of HS and results after TAVI remain scarce.

Methods

2548 consecutive patients who underwent TAVI for the treatment of AS from 2008 to 2017 were evaluated for a history of GIB and the presence of HS. The diagnosis of HS was defined as a clinical triad of severe AS, a history of recurrent GIB, and an endoscopic diagnosis of angiodysplasia. These patients (Heyde) were followed to investigate clinical outcomes, bleeding complications and the recurrence of GIB and were compared to patients with GIB unrelated to HS (Non-Heyde).

Results

A history of GIB prior to TAVI was detected in 190 patients (7.5%). Among them, 47 patients were diagnosed with HS (1.8%). Heyde patients required blood transfusions more frequently compared to Non-Heyde patients during index hospitalization (50.0% vs. 31.9%, p = 0.03). Recurrent GIB was detected in 39.8% of Heyde compared to 21.2% of Non-Heyde patients one year after TAVI (p = 0.03). In patients diagnosed with HS and recurrent GIB after TAVI, the rate of residual ≥ mild paravalvular leakage (PVL) was higher compared to those without recurrent bleeding (73.3% vs. 38.1%, p = 0.05).

Conclusion

A relevant number of patients undergoing TAVI were diagnosed with HS. Recurrent GIB was detected in a significant number of Heyde patients during follow-up. A possible association with residual PVL requires further investigation to improve treatment options and outcomes in patients with HS.

Graphic abstract

中文翻译：

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海德综合征：经导管主动脉瓣植入术患者的患病率和结局

背景

海德综合征 (HS) 被称为严重主动脉瓣狭窄 (AS) 和血管发育不良引起的复发性胃肠道出血 (GIB) 的关联。TAVI 后 HS 的患病率和结果的数据仍然很少。

方法

对 2008 年至 2017 年连续接受 TAVI 治疗 AS 的 2548 名患者进行了 GIB 病史和 HS 的评估。HS 的诊断被定义为严重 AS 的临床三联征、复发性 GIB 病史和血管发育不良的内镜诊断。对这些患者 (Heyde) 进行随访以调查临床结果、出血并发症和 GIB 的复发，并与与 HS 无关的 GIB 患者 (Non-Heyde) 进行比较。

结果

在 190 名患者 (7.5%) 中检测到 TAVI 之前的 GIB 病史。其中，47例患者被诊断为HS（1.8%）。与非海德患者相比，海德患者在首次住院期间需要输血的频率更高（50.0% 对 31.9%，p  = 0.03）。在 TAVI 一年后，Heyde 的 39.8% 的患者检测到复发性 GIB，而非海德患者的这一比例为 21.2%（p  = 0.03）。在 TAVI 后诊断为 HS 和复发性 GIB 的患者中，残留≥轻度瓣周漏 (PVL) 的发生率高于没有复发性出血的患者 (73.3% vs. 38.1%, p  = 0.05)。

结论

相关数量的接受 TAVI 的患者被诊断为 HS。在随访期间，大量 Heyde 患者发现了复发性 GIB。与残留 PVL 的可能关联需要进一步调查以改善 HS 患者的治疗选择和结果。

图形摘要