Comparison of Frequency of Late Gastrointestinal Bleeding With Transcatheter Versus Surgical Aortic Valve Replacement

Iyengar, Amit; Sanaiha, Yas; Aguayo, Esteban; Seo, Young-Ji; Dobaria, Vishal; Toppen, William; Shemin, Richard J.; Benharash, Peyman

doi:10.1016/j.amjcard.2018.07.047

Cited by 10 publications

(5 citation statements)

References 21 publications

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“…Moreover, TAVI is superior to SAVR in lessening the duration of hospitalization and the incidence of periprocedural complications such as stroke, myocardial infarction, or major or life-threatening bleeding. Nevertheless, TAVI is pointed out to be prone to complicate paravalvular regurgitation 26.6% vs. 4.2%, P<0.001 and associated with a higher incidence of advanced GIB 3.3% vs. 1.5%, P<0.001 compared to SAVR (12,13). Our patient, categorized as the population of extremely high bleeding risk in operation, consequently received TAVI to treat to avoid surgical complications and increase the bene t of valve replacement.…”

Section: Diagnosismentioning

confidence: 84%

Did the Angiodysplasia Associated With Heyde's Syndrome Disappear Spontaneously?: A Case Report

Zhang

Shi

et al. 2021

Preprint

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Background: Multidisciplinary clinical manifestations of Heyde's syndrome and finite accuracy of corresponding examinations toward Heyde's triad make it easily omitted or misjudged in practice. Moreover, aortic valve replacement is often delayed because of the contradiction between anticoagulation and hemostasis. Herein, we present a rare case of atypical Heyde's syndrome whose confirmed intermittent bleeding angiodysplasia was not observed via mesenteric arteriography again, but severe bleeding was dramatically improved by transcatheter aortic valve implantation(TAVI) following laparotomy.Case presentation: A 64-year-old female experienced refractory gastrointestinal bleeding and deteriorating exertional dyspnea with a history of hypertension. Exploratory laparotomy was performed because the hemorrhage persisted and repeated transfusions. The subsequent histological examination revealed angiodysplasia. Heyde's syndrome was not suspected until she bled again combined with aortic valve stenosis detected by echocardiography 3 years later. TAVI was consequently performed in a stable condition with the invisibility of angiodysplasia. The post-procedure and follow-up were uneventful.Conclusions: The visible figures of angiodysplasia or shortage of HMWM-vWFs should not be indispensable for the clinical diagnosis of Heyde's syndrome. Laparotomy could be a bridging therapy to aortic valve replacement for severe hemorrhagic patients, and TAVI may benefit high-risk patients with a stable condition.

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Section: Diagnosismentioning

confidence: 84%

Did the Angiodysplasia Associated With Heyde's Syndrome Disappear Spontaneously?: A Case Report

Zhang

Shi

et al. 2021

Preprint

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“…These included stroke or transient ischemic attack (TIA), prolonged ventilation (>96 hours), acute kidney injury (AKI), reoperation, major bleeding, and vascular complications [ 20 ]. Major bleeding consisted of gastrointestinal bleed, postoperative hematoma or hemorrhage, hemoptysis, epistaxis, intracranial hemorrhage, and requirement for blood transfusion [ 21 , 22 ]. Meanwhile, vascular complications comprised of injuries to blood vessels, accidental puncture or laceration of a circulatory system organ or structure, and acute limb ischemia [ 23 – 25 ].…”

Section: Methodsmentioning

confidence: 99%

Mortality and resource utilization in surgical versus transcatheter repeat mitral valve replacement: A national analysis

Le,

Chervu,

Mallick

et al. 2024

PLoS ONE

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Background Transcatheter mitral valve replacement (TMVR) has garnered interest as a viable alternative to the traditional surgical mitral valve replacement (SMVR) for high-risk patients requiring redo operations. This study aims to evaluate the association of TMVR with selected clinical and financial outcomes. Methods Adults undergoing isolated redo mitral valve replacement were identified in the 2016–2020 Nationwide Readmissions Database and categorized into TMVR or SMVR cohorts. Various regression models were developed to assess the association between TMVR and in-hospital mortality, as well as additional secondary outcomes. Transseptal and transapical catheter-based approaches were also compared in relation to study endpoints. Results Of an estimated 7,725 patients, 2,941 (38.1%) underwent TMVR. During the study period, the proportion of TMVR for redo operations increased from 17.8% to 46.7% (nptrend<0.001). Following adjustment, TMVR was associated with similar odds of in-hospital mortality (AOR 0.82, p = 0.48), but lower odds of stroke (AOR 0.44, p = 0.001), prolonged ventilation (AOR 0.43, p<0.001), acute kidney injury (AOR 0.61, p<0.001), and reoperation (AOR 0.29, p = 0.02). TMVR was additionally correlated with shorter postoperative length of stay (pLOS; β -0.98, p<0.001) and reduced costs (β -$10,100, p = 0.002). Additional analysis demonstrated that the transseptal approach had lower adjusted mortality (AOR 0.44, p = 0.02), shorter adjusted pLOS (β -0.43, p<0.001), but higher overall costs (β $5,200, p = 0.04), compared to transapical. Conclusions In this retrospective cohort study, we noted TMVR to yield similar odds of in-hospital mortality as SMVR, but fewer complications and reduced healthcare expenditures. Moreover, transseptal approaches were associated with lower adjusted mortality, shorter pLOS, but higher cost, relative to the transapical. Our findings suggest that TMVR represent a cost-effective and safe treatment modality for patients requiring redo mitral valve procedures. Nevertheless, future studies examining long-term outcomes associated with SMVR and TMVR in redo mitral valve operations, are needed.

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“…Nevertheless, patients who had TAVI might be prone to complicate with paravalvular regurgitation (26.6% vs. 4.2%, P < 0.001) which is independently associated with the risk of re-bleeding(OR, 3.65 [95%CI, 1.36–9.80]; P = 0.01), and higher incidence of late-stage GIB (3.3% vs. 1.5%, P < 0.001) than SAVR [ 12 , 15 , 16 ]. In addition, an observational study including 890 patients undergoing transcatheter or surgical bioprosthetic aortic valve replacement found that the incidence of subclinical leaflet thrombosis following TAVI was significantly higher than after SAVR (13% vs. 4%, P = 0.001) in a median follow-up period of 83 days.…”

Section: Diagnosismentioning

confidence: 99%

Did angiodysplasia associated with heyde’s syndrome disappear spontaneously?: a case report

Shi

et al. 2023

J Cardiothorac Surg

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Background Heyde’s syndrome can be easily overlooked or misjudged in clinical practice because it shares common clinical manifestations with multiple diseases as well as limited accuracy of several corresponding examinations for diagnosing Heyde’s triad. Moreover, aortic valve replacement is often delayed in these patients due to the contradiction between anticoagulation and hemostasis. Herein, we present a rare case of atypical Heyde’s syndrome. The patient’s severe intermittent gastrointestinal bleeding was not completely cured even through a local enterectomy. In the absence of direct evidence of acquired von Willebrand syndrome (AVWS) or angiodysplasia, her long-standing gastrointestinal bleeding was finally stopped after receiving transcatheter aortic valve implantation (TAVI). Case presentation A 64-year-old female suffered from refractory gastrointestinal bleeding and exertional dyspnoea. A local enterectomy was performed owing to persistent hemorrhage and repeated transfusions; subsequently, histological examination revealed angiodysplasia. Heyde’s syndrome was not suspected until 3 years later, at which time the patient started bleeding again and was also found to have severe aortic valve stenosis upon echocardiography. TAVI was consequently performed when the patient was in a relatively stable condition even though the predisposition to bleed, but there was no evidence of angiodysplasia and AVWS during angiography at that time. The patient’s above symptoms were significantly relieved after TAVI and followed up for 2 years without any significant ischemic or bleeding events. Conclusions The visible characteristics of angiodysplasia or a shortage of HMWM-vWFs should not be indispensable for the clinical diagnosis of Heyde’s syndrome. Enterectomy could be a bridging therapy for aortic valve replacement in patients with severe hemorrhage, and TAVI may be beneficial for moderate to high surgical-risk patients even if they have a potential risk of bleeding.

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Comparison of Frequency of Late Gastrointestinal Bleeding With Transcatheter Versus Surgical Aortic Valve Replacement

Cited by 10 publications

References 21 publications

Did the Angiodysplasia Associated With Heyde's Syndrome Disappear Spontaneously?: A Case Report

Did the Angiodysplasia Associated With Heyde's Syndrome Disappear Spontaneously?: A Case Report

Mortality and resource utilization in surgical versus transcatheter repeat mitral valve replacement: A national analysis

Did angiodysplasia associated with heyde’s syndrome disappear spontaneously?: a case report

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