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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation

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Frequency, Timing, and Impact of Access-Site and Non-Access-Site Bleeding on Mortality Among Patients Undergoing

Raffaele Piccolo1, Thomas Pilgrim1, Anna Franzone1

  • 1Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland.

JACC. Cardiovascular Interventions
|July 22, 2017
PubMed

Insights

Bleeding after transcatheter aortic valve replacement (TAVR) increases mortality risk. Non-access-site bleeding poses a significantly higher mortality risk than access-site bleeding in TAVR patients.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Clinical Outcomes Research

Background:

  • Bleeding complications are common in patients undergoing transcatheter aortic valve replacement (TAVR).
  • The prognostic impact of bleeding location (access-site vs. non-access-site) after TAVR remains unclear.
  • Understanding bleeding site impact is crucial for improving TAVR patient outcomes.

Purpose of the Study:

  • To investigate the frequency and timing of access-site and non-access-site bleeding post-TAVR.
  • To assess the association of bleeding location with long-term mortality after TAVR.
  • To compare the mortality risk conferred by access-site versus non-access-site bleeding.

Main Methods:

  • Retrospective analysis of 926 consecutive patients undergoing TAVR (2007-2014).
  • Bleeding events classified using Valve Academic Research Consortium 2 criteria.
  • Primary outcome: All-cause mortality assessed up to 5 years post-procedure.

Main Results:

  • 30.7% of patients experienced bleeding within 5 years.
  • Both access-site (HR: 1.34) and non-access-site bleeding (HR: 2.08) significantly increased mortality risk.
  • Non-access-site bleeding demonstrated a substantially higher mortality risk (HR: 1.56) compared to access-site bleeding.

Conclusions:

  • Access-site and non-access-site bleeding are independent predictors of increased mortality after TAVR.
  • Non-access-site bleeding is associated with the greatest mortality risk in the long-term follow-up.
  • Factors like female sex, chronic kidney disease, and STS score correlate with specific bleeding types.
Abstract

Keywords:
TAVRaccess-site bleedingaortic stenosisbleedingnon–access-site bleeding

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