Title :

Primary Hemostatic Disorders and Late Major Bleeding After Transcatheter Aortic Valve Replacement Auteurs

Author(s) :

Kibler, Marion [Auteur]
Université de Strasbourg [UNISTRA]
CHU Strasbourg
Nouvel Hôpital Civil de Strasbourg
Marchandot, Benjamin [Auteur]
Université de Strasbourg [UNISTRA]
CHU Strasbourg
Nouvel Hôpital Civil de Strasbourg
Messas, Nathan [Auteur]
Université de Strasbourg [UNISTRA]
CHU Strasbourg
Nouvel Hôpital Civil de Strasbourg
Labreuche, Julien [Auteur]
Flavien, Vincent [Auteur]
Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires [RNMCD - U1011]
Institut Coeur Poumon [CHU Lille]
Grunenbaum, Leila [Auteur]
CHU Strasbourg
Hoang, Viet Anh [Auteur]
Reydel, Antje [Auteur]
Université de Strasbourg [UNISTRA]
CHU Strasbourg
Nouvel Hôpital Civil de Strasbourg
Crimizade, Ulun [Auteur]
Université de Strasbourg [UNISTRA]
CHU Strasbourg
Nouvel Hôpital Civil de Strasbourg
Kindo, Michel [Auteur]
Université de Strasbourg [UNISTRA]
CHU Strasbourg
Nouvel Hôpital Civil de Strasbourg
Hoang Minh, T. [Auteur]
Université de Strasbourg [UNISTRA]
CHU Strasbourg
Nouvel Hôpital Civil de Strasbourg
Zeyons, Floriane [Auteur]
Université de Strasbourg [UNISTRA]
CHU Strasbourg
Nouvel Hôpital Civil de Strasbourg
Trinh, Annie [Auteur]
Université de Strasbourg [UNISTRA]
CHU Strasbourg
Nouvel Hôpital Civil de Strasbourg
Petit-Eisenmann, Hélène [Auteur]
Université de Strasbourg [UNISTRA]
CHU Strasbourg
Nouvel Hôpital Civil de Strasbourg
de Poli, Fabien [Auteur]
Centre hospitalier de Haguenau
Leddet, Pierre [Auteur]
Centre hospitalier de Haguenau
Duhamel, Alain [Auteur]
Jesel, Laurence [Auteur]
CHU Strasbourg
Nouvel Hôpital Civil de Strasbourg
Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research [C2VN]
Ohana, Mickaël [Auteur]
CHU Strasbourg
Nouvel Hôpital Civil de Strasbourg
Susen, Sophie [Auteur]
Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires [RNMCD - U1011]
Ohlmann, Patrick [Auteur]
Université de Strasbourg [UNISTRA]
CHU Strasbourg
Nouvel Hôpital Civil de Strasbourg
Van Belle, Eric [Auteur]
Institut Coeur Poumon [CHU Lille]
Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires [RNMCD - U1011]
Morel, Olivier [Auteur]
CHU Strasbourg
Nouvel Hôpital Civil de Strasbourg
Nanomédecine Régénérative [NanoRegMed]

Journal title :

Journal of the American College of Cardiology

Publisher :

Elsevier

Publication date :

2018

ISSN :

0735-1097

English keyword(s) :

aortic stenosis
late major/life-threatening bleeding
paravalvular aortic regurgitation
transcatheter aortic valve replacement
von Willebrand syndrome

HAL domain(s) :

Informatique [cs]/Traitement des images [eess.IV]

English abstract : [en]

BACKGROUND: Periprocedural and late (>30 days) bleedings represent major complications after transcatheter aortic valve replacement and have been identified as potential areas for improved patient care. OBJECTIVES: The ...
Show more >BACKGROUND: Periprocedural and late (>30 days) bleedings represent major complications after transcatheter aortic valve replacement and have been identified as potential areas for improved patient care. OBJECTIVES: The authors sought to evaluate the impact of ongoing primary hemostasis disorders on late major/life-threatening bleeding complications (MLBCs). METHODS: Bleedings were assessed according to the VARC-2 (Valve Academic Research Consortium-2) criteria. Closure time of adenosine diphosphate (CT-ADP), a surrogate marker of high molecular weight von Willebrand multimers proteolysis was assessed 24 h after the procedure. Ongoing primary hemostasis disorder was defined by a CT-ADP >180 s. RESULTS: Among 372 patients who survived at 30 days, MLBCs occurred in 42 patients (11.3%) at a median follow-up of 383 days (interquartile range: 188 to 574 days). MLBCs were mainly of gastrointestinal origin (42.8%) and were associated with increased overall mortality (hazard ratio [HR]: 5.66; 95% confidence interval [CI]: 3.10 to 10.31; p < 0.001) and cardiac mortality (HR: 11.62; 95% CI: 4.59 to 29.37; p < 0.001). A 2.5-fold elevation of MLBCs could be evidenced in patients with a CT-ADP > 180 s (27.4% vs. 11.5%; p < 0.001). Multivariate regression analysis identified paravalvular leak (PVL) (HR: 6.31; 95% CI: 3.43 to 11.60; p < 0.0001) and CT-ADP > 180 s (HR: 3.08; 95% CI: 1.62 to 5.81; p = 0.0005) as predictor of MLBCs. CONCLUSIONS: MLBCs after transcatheter aortic valve replacement are frequent and associated with an increased morbidity and mortality. PVL and CT-ADP >180 s were identified as strong predictors for MLBCs. These findings strongly suggest that persistent HMW defects contribute to enhanced bleeding risk in patients with residual PVL.Show less >

Language :

Anglais

Peer reviewed article :

Oui

Audience :

Non spécifiée

Popular science :

Non

Collections :

• Récepteurs nucléaires, Maladies Cardiovasculaires et Diabète (EGID) - U1011

Source :

Harvested from HAL