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Incidence, Predictors, and Prognostic Impact of Bleeding Events After TAVR According to VARC-3 Criteria.
Avvedimento, Marisa; Real, Carlos; Nuche, Jorge; Farjat-Pasos, Julio; Galhardo, Attilio; Trinh, Kim-Hoang; Robichaud, Mathieu; Delarochellière, Robert; Paradis, Jean-Michel; Poulin, Anthony; Dumont, Eric; Kalavrouziotis, Dimitris; Mohammadi, Siamak; Côté, Mélanie; Rodés-Cabau, Josep.
Afiliación
  • Avvedimento M; Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
  • Real C; Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada; Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain.
  • Nuche J; Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
  • Farjat-Pasos J; Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
  • Galhardo A; Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
  • Trinh KH; Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
  • Robichaud M; Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
  • Delarochellière R; Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
  • Paradis JM; Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
  • Poulin A; Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
  • Dumont E; Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
  • Kalavrouziotis D; Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
  • Mohammadi S; Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
  • Côté M; Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
  • Rodés-Cabau J; Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada; Clínic Barcelona, Barcelona, Spain. Electronic address: josep.rodes@criucpq.ulaval.ca.
JACC Cardiovasc Interv ; 16(18): 2262-2274, 2023 09 25.
Article en En | MEDLINE | ID: mdl-37676226
BACKGROUND: The updated Valve Academic Research Consortium (VARC) definition for bleeding events after transcatheter aortic valve replacement (TAVR) lacks of clinical validation. OBJECTIVES: The aim of this study was to determine the incidence, predictors, and clinical impact of bleeding events following TAVR as defined by recent VARC-3 criteria. METHODS: A total of 2,384 consecutive patients with severe symptomatic aortic stenosis undergoing TAVR were included. Early (at index hospitalization) and late (after hospital discharge) bleeding complications were defined according to VARC-3 criteria as type 1, 2, 3, or 4. Baseline, procedural, and follow-up (24 [IQR: 12-43] months) data were prospectively collected. RESULTS: Bleeding events occurred in 761 patients (31.9%): types 1, 2, 3, and 4 in 169 (22.2%), 399 (52.4%), 149 (19.6%), and 44 (5.8%) patients, respectively. The primary vascular access site and gastrointestinal locations were the most common bleeding sources among early and late bleeding events, respectively. Female sex, thoracotomy access, larger (14-F) sheath use, and dual antiplatelet therapy determined an increased risk of early bleeding events (P < 0.02 for all). The use of the radial artery for secondary access was associated with a significant risk reduction of early bleeding (P < 0.001). Type 2 and type 3 events were associated with an increased mortality risk at 30-day (HR: 2.94 [95% CI: 1.43-6.03; P = 0.003] and HR: 4.91 [95% CI: 2.19-11.03; P < 0.001], respectively) and 1-year (HR: 1.86 [95% CI: 1.28-2.69; P = 0.001] and HR: 2.28 [95% CI: 1.41-3.66; P = 0.001], respectively) follow-up. A similar prognostic pattern was observed when applying VARC-2 criteria but with a much lower global incidence of early bleeding events (19% vs 27%; P < 0.001). CONCLUSIONS: Bleeding events after TAVR were associated with poorer short- and long-term survival. The magnitude of this correlation was proportional to bleeding severity defined according to VARC-3 criteria. Further studies on bleeding prevention following TAVR are warranted to improve procedural safety and patient prognosis.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Estenosis de la Válvula Aórtica / Reemplazo de la Válvula Aórtica Transcatéter Tipo de estudio: Etiology_studies / Incidence_studies / Prognostic_studies / Risk_factors_studies Límite: Female / Humans Idioma: En Revista: JACC Cardiovasc Interv Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2023 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Estenosis de la Válvula Aórtica / Reemplazo de la Válvula Aórtica Transcatéter Tipo de estudio: Etiology_studies / Incidence_studies / Prognostic_studies / Risk_factors_studies Límite: Female / Humans Idioma: En Revista: JACC Cardiovasc Interv Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2023 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos