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Updated: May 26, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Usefulness of periprocedural bleeding to predict outcome after transcatheter aortic valve implantation
Brian P Halliday1, Rafal Dworakowski, Beth Brickham
1Department of Cardiology, King's College Hospital, Kings Health Partners, Denmark Hill, London, United Kingdom.
Insights
Life-threatening bleeding after transcatheter aortic valve implantation predicts poor outcomes. Patient factors like vascular disease and diabetes increase bleeding risk, highlighting the need for careful management.
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Cardiology
Background:
- Bleeding complications are recognized predictors of adverse outcomes in cardiac interventions.
- The Valve Academic Research Consortium (VARC) introduced a new definition for bleeding events.
Purpose of the Study:
- To evaluate if the new VARC bleeding definition predicts outcomes after transcatheter aortic valve implantation (TAVI).
- To identify patient characteristics associated with periprocedural bleeding.
- To assess the impact of blood transfusion on outcomes following TAVI.
Main Methods:
- Retrospective analysis of 101 patients undergoing TAVI (transapical or transfemoral) between August 2007 and November 2010.
- Examination of the association between bleeding, blood transfusion, and in-hospital and 6-month mortality.
- Logistic regression modeling to identify predictors of bleeding.
Main Results:
- Life-threatening bleeding occurred in 4.9% of patients.
- Patients with life-threatening bleeding had significantly higher in-hospital mortality (60.0% vs 7.3%).
- Life-threatening bleeding, hemoglobin decrease >5 g/dl, and >2 U blood transfusion were linked to increased 6-month mortality. Vascular disease, diabetes, and preprocedural anemia predicted bleeding incidence.
Conclusions:
- Life-threatening periprocedural bleeding after TAVI is associated with poorer patient outcomes.
- The VARC bleeding definition appears relevant for predicting outcomes in TAVI patients.
- Preprocedural patient factors like anemia and comorbidities influence bleeding risk, necessitating targeted management strategies.
Abstract:
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.
