TY - JOUR
T1 - Reduction of Gastrointestinal Bleeding in Patients with Heyde Syndrome Undergoing Transcatheter Aortic Valve Implantation
AU - Goltstein, Lia C. M. J.
AU - Rooijakkers, Maxim J. P.
AU - Görtjes, Natasha C. C.
AU - Akkermans, Reinier P.
AU - Zegers, Erwin S.
AU - Pisters, Ron
AU - van Wely, Marleen H.
AU - van der Wulp, Kees
AU - Drenth, Joost P. H.
AU - van Geenen, Erwin J. M.
AU - van Royen, Niels
N1 - Funding Information:
This study was funded by the Netherlands Organisation for Health Research and Development (ZonMw; grant number 848017006) and the Radboud University Medical Center. ZonMw and the Radboud University Medical Center had no role in study design, data collection, data analyses, data interpretation, or report preparation.
Funding Information:
Dr Drenth has received research funding from Gilead to support hepatitis C elimination in the Netherlands. Dr van Geenen has received research funding from Viatris, Boston Scientific, and Olympus and served as a consultant for MTW-Endoskopie and Microtech. Dr van Royen has received research funding from Abbott, Philips, and Biotronik; has served as a consultant for RainMed, Castor, and Medtronic; and received speaker fees from Abbott. The other authors report no conflicts.
Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/7/1
Y1 - 2022/7/1
N2 - 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.
AB - 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.
KW - angiodysplasia
KW - aortic valve stenosis
KW - capillaries
KW - hemorrhage
KW - prevalence
KW - transcatheter aortic valve replacement
UR - http://www.scopus.com/inward/record.url?scp=85134491804&partnerID=8YFLogxK
U2 - 10.1161/CIRCINTERVENTIONS.122.011848
DO - 10.1161/CIRCINTERVENTIONS.122.011848
M3 - Article
C2 - 35861798
SN - 1941-7640
VL - 15
SP - E011848
JO - Circulation-cardiovascular interventions
JF - Circulation-cardiovascular interventions
IS - 7
ER -