How does major bleeding influence decision-making in patients eligible for transfemoral TAVI? A single-center...

To evaluate the impact of bleeding on the risk-benefit balance of coronary revascularization prior to transfemoral transcatheter aortic valve implantation (TF-TAVI).

We conducted a retrospective analysis of the patients who underwent TF-TAVI at our center between 2008 and 2018 to evalute the management of coronary artery disease (percutaneous revascularization vs no revascularization). Subsequently, the rate of major bleeding -defined according to the Bleeding Academic Research Consortium (BARC) criteria (type 3-5)- and major adverse cardiovascular events (MACE) was compared between the 2 groups over a mean 60-month follow-up period.

A total of 379 patients were included. The overall rate of major bleeding was 21.4%, higher in revascularized patients but without reaching statistical significance. The rate of major bleeding between coronary angiography and TF-TAVI implantation was 5.5% and significantly higher in revascularized patients (12.0% vs 3.5%; P = .07). During the hospitalization for TF-TAVI and throughout follow-up, the rate of major bleeding was 6.1% and 9.6%, respectively, with no significant inter-group differences. There were no significant differences either in the 5-year rate of MACE.

In our patient cohort, pre-TF-TAVI preoperative coronary revascularization was associated with an initially higher bleeding risk; however, no statistically significant differences were observed in major bleeding or MACE at the 5-year follow-up. These findings support the need to generate high-quality clinical evidence to demonstrate the net clinical benefit of coronary revascularization in this context.