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Reduction of Gastrointestinal Bleeding in Patients With Heyde Syndrome Undergoing Transcatheter Aortic Valve Implantation
Circulation: Cardiovascular Interventions ( IF 5.6 ) Pub Date : 2022-07-05 , DOI: 10.1161/circinterventions.122.011848
Lia C M J Goltstein 1 , Maxim J P Rooijakkers 2 , Natasha C C Görtjes 1 , Reinier P Akkermans 3 , Erwin S Zegers 4 , Ron Pisters 5 , Marleen H van Wely 2 , Kees van der Wulp 2 , Joost P H Drenth 1 , Erwin J M van Geenen 1 , Niels van Royen 2
Affiliation  

Background:Heyde syndrome is the co-occurrence of aortic stenosis and gastrointestinal bleeding secondary to angiodysplasias. Surgical aortic valve replacement effectively reduces bleeding, but the effects of transcatheter aortic valve implantation (TAVI) are largely unknown. This study aimed to describe the reduction of gastrointestinal bleeding in patients with Heyde syndrome after TAVI and to identify the factors associated with rebleeding.Methods:We enrolled patients with Heyde syndrome from a prospective TAVI registry. Gastrointestinal bleeding episodes were assessed by the Bleeding Academic Research Consortium classification, and cumulative incidence functions were used to calculate cessation rates. Factors potentially associated with rebleeding were analyzed using logistic regression. Differences between Heyde and non-Heyde patients were assessed through a case-cohort study.Results:Between December 2008 and June 2020, 1111 patients underwent TAVI. There were 70 patients with Heyde syndrome (6.3%). In the first year following TAVI, gastrointestinal bleeding ceased in 46 of 70 patients (62% [95% CI, 50%–74%]). Bleeding episodes decreased from 3.2 (95% CI, 2.5–4.2) to 1.6 ([95% CI, 1.2–2.2] P=0.001) and hemoglobin levels increased from 10.3 (95% CI, 10.0–10.8) to 11.3 (95% CI, 10.8–11.6) g/dL (P=0.007). Between 1 and 5 years after TAVI (35 [interquartile range, 21–51] months), 53 of 62 patients (83% [95% CI, 72%–92%]) no longer experienced gastrointestinal bleeding. Paravalvular leakage (≥mild) was associated with rebleeding risk (odds ratio, 3.65 [95% CI, 1.36–9.80]; P=0.010). Periprocedural bleeding was more common in Heyde than in control patients (adjusted odds ratio, 2.55 [95% CI, 1.37–4.73]; P=0.003).Conclusions:Patients with Heyde syndrome are at increased risk for periprocedural bleeding. Post-TAVI, gastrointestinal bleeding disappears in the majority of patients. Paravalvular leakage may curtail these clinical benefits.

中文翻译:

经导管主动脉瓣植入术可减少海德综合征患者的胃肠道出血

背景:海德综合征是主动脉瓣狭窄和血管发育不良继发的消化道出血同时发生的疾病。外科主动脉瓣置换术可有效减少出血,但经导管主动脉瓣植入术 (TAVI) 的效果尚不清楚。本研究旨在描述海德综合征患者 TAVI 后胃肠道出血的减少情况,并确定与再出血相关的因素。方法:我们从前瞻性 TAVI 登记处招募了海德综合征患者。胃肠道出血事件通过出血学术研究联盟分类进行评估,并使用累积发生率函数来计算停止率。使用逻辑回归分析可能与再出血相关的因素。通过病例队列研究评估了 Heyde 和非 Heyde 患者之间的差异。结果:2008 年 12 月至 2020 年 6 月期间,1111 名患者接受了 TAVI。70 名海德综合征患者(6.3%)。在 TAVI 治疗后的第一年,70 名患者中的 46 名患者停止了胃肠道出血(62% [95% CI,50%–74%])。出血次数从 3.2 (95% CI, 2.5–4.2) 减少至 1.6 ([95% CI, 1.2–2.2] P =0.001),血红蛋白水平从 10.3 (95% CI, 10.0–10.8) 增加至 11.3 (95% CI,10.8–11.6)g/dL(P =0.007)。TAVI 后 1 至 5 年(35 [四分位距,21–51] 个月)期间,62 名患者中的 53 名(83% [95% CI,72%–92%])不再经历胃肠道出血。瓣周漏(≥轻度)与再出血风险相关(比值比,3.65 [95% CI,1.36–9.80];P = 0.010)。Heyde 患者的围手术期出血比对照患者更常见(调整后的比值比,2.55 [95% CI,1.37–4.73];P = 0.003)。结论:Heyde 综合征患者围手术期出血的风险增加。TAVI 后,大多数患者的胃肠道出血消失。瓣周漏可能会削弱这些临床益处。
更新日期:2022-07-05
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