Impact of High Body Mass Index on Vascular and Bleeding Complications After Transcatheter Aortic Valve Implantation

Berti, Sérgio; Bartorelli, Antonio L.; Koni, Endrin; Giordano, Arturo; Petronio, Anna Sonia; Iadanza, Alessandro; Bedogni, Francesco; Reimers, Bernhard; Spaccarotella, Carmen; Trani, Carlo; Attisano, Tiziana; Sardella, Gennaro; Bonmassari, Roberto; Medda, Massimo; Sherwood, Matthew W.; Tomai, Fabrizio; Navarese, Eliano Pio

doi:10.1016/j.amjcard.2021.06.015

Cited by 16 publications

(6 citation statements)

References 31 publications

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“…Particularly higher BMI levels have been associated with higher bleeding risk, but conflicting results have been published. 31 32 33 However, in our cohort the difference was only modest potentially explaining the lack of association after adjustment for confounders.…”

Section: Discussioncontrasting

confidence: 64%

Impact of ABO Blood Group on Thromboembolic and Bleeding Complications in Patients with Left Ventricular Assist Devices

et al. 2022

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Background: The ABO blood group system is linked to hemostasis via its relationship with von Willebrand factor (VWF) and factor VIII (FVIII). In the current study, we investigated the association of the ABO system with clinical outcomes as well as VWF and platelet function in patients with left ventricular assist devices (LVADs). Methods: Bleeding and thromboembolic complications were assessed in 111 patients during 1 year after LVAD implantation. In 67 LVAD patients, VWF antigen, VWF activity, VWF ristocetin cofactor, VWF collagen-binding and FVIII activity were assessed. Platelet surface P-selectin and activated glycoprotein IIb/IIIa were determined by flow cytometry, and soluble P-selectin was measured with an enzyme-linked immunoassay. Platelet aggregation was assessed by light transmission and impedance aggregometry. Results: Thirty-six patients (32.4%) experienced a bleeding and 22 patients (19.8%) had a thromboembolic event. In univariate analyses, patients with blood group O had numerically more bleeding complications and less thromboembolic events as compared to patients with blood group non-O (both p≥0.085). After multivariable adjustment, blood group O was significantly associated with a higher risk of bleeding (HR 2.42 [95% CI 1.03-5.70], p=0.044) but not linked to thromboembolic complications. Patients with blood group O had significantly lower levels of VWF and FVIII (all p<0.05), whereas P-selectin expression in response to thrombin-receptor activating peptide and soluble P-selectin were higher as compared to patients with blood group non-O (both p <0.05). Conclusion: LVAD patients with blood group O are at an increased bleeding risk , potentially due to lower VWF and FVIII levels.

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Section: Discussioncontrasting

confidence: 64%

Impact of ABO Blood Group on Thromboembolic and Bleeding Complications in Patients with Left Ventricular Assist Devices

et al. 2022

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“…Although previous studies showed that overweight and obese patients with established cardiovascular diseases tend to have a lower incidence of all‐cause death, 27 the impacts of high BMI on complications of TAVI were not always positive, 28 and prior studies also found that overweight and obesity were risk factors for chronic kidney disease. 29 This study showed that high BMI (≥25 kg/m 2 ) was one of the risk factors for irreversible hepatorenal dysfunction.…”

Section: Discussionmentioning

confidence: 97%

Prognostic value of the dynamic hepatorenal function on intermediate‐term mortality in TAVI patients with survival to discharge

Yao

Xiong

et al. 2022

Clinical Cardiology

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Background Renal and liver dysfunctions are risk factors for mortality in patients with severe aortic stenosis (AS). Transcatheter aortic valve implantation (TAVI) has the potential to break the vicious cycle between AS and hepatorenal dysfunction by relieving aortic valve obstruction. Hypothesis A part of patients can derive hepatorenal function improvement from TAVI, and this noncardiac benefit improves the intermediate‐term outcomes. Methods We developed this retrospective cohort study in 439 consecutive patients undergoing TAVI and described the dynamic hepatorenal function assessed by model for end‐stage liver disease model for end‐stage liver disease (MELD)‐XI score in subgroups. The endpoint was 2‐year all‐cause mortality. Results Receiver‐operating characteristic analysis showed that the baseline MELD‐XI score of 10.71 was the cutoff point. A high MELD‐XI score (>10.71) at baseline was an independent predictor of the 2‐year mortality hazard ratio (HR: 2.65 [1.29–5.47], p = .008). After TAVI, patients with irreversible high MELD‐XI scores had a higher risk of 2‐year mortality than patients who improved from high to low MELD‐XI scores (HR: 2.50 [1.06–5.91], p = .03). Factors associated with reversible MELD‐XI scores improvement were low baseline MELD‐XI scores (≤12.00, odds ratio [OR]: 2.02 [1.04–3.94], p = .04), high aortic valve peak velocity (≥5 m/s, OR: 2.17 [1.11–4.24], p = .02), and low body mass index (≤25 kg/m 2 , OR: 2.73 [1.25–5.98], p = .01). Conclusion High MELD‐XI score at baseline is an independent predictor for 2‐year mortality. Patients with hepatorenal function improvement after TAVI have better outcomes. For patients with irreversible hepatorenal dysfunction after TAVI, further optimization of the subsequent treatment after TAVI is needed to improve the outcomes.

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“…Obesity and small femoral artery diameter with deep arteriotomy or greater vessel depth from skin puncture site appear to be strong patient-related variables associated with large-bore arterial access VCD failures. 16,17 The initial MANTA depth locator measurement can be significantly different than the measurement toward the end of the procedure where this depth measurement is used for final deployment. A deeper arteriotomy site has been associated with increased MANTA-related vascular access site complications.…”

Section: Discussionmentioning

confidence: 99%

Alternative Application Technique for the MANTA Vascular Closure Device for Percutaneous Large-Bore Arterial Access Closure: The Fluoroscopic DOT Technique

et al. 2022

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Background: Vascular complications are a cause of increased morbidity and mortality when performing percutaneous procedures requiring large-bore arterial access. MANTA vascular closure device (VCD) is currently the only large-bore VCD using an intraluminal foot plate and an extraluminal collagen plug. The traditional depth locator approach might be compromised in; emergent cases without the required measurements, cases of hematoma formation, or other patient, procedure, or operator-specific variables. Furthermore, this technique can be used for postclosure in cases without the required measurement of depth. We describe vascular outcomes using fluoroscopy (fluoroscopic DOT technique) rather than traditional depth locator approach for vascular closure with the MANTA VCD. Methods: Fifty patients who underwent transcatheter aortic valve implantation (TAVI) were retrospectively analyzed using fluoroscopic DOT technique with 18F MANTA VCD between May and August 2021. All patients >18 years of age who qualified for transfemoral TAVI were included. Access was obtained with ultrasound guidance with vessel diameter of at least > 6 mm and free from anterior vessel wall calcification. Patient related factors and primary outcomes of access site bleeding and acute flow-limited limb ischemia requiring intervention were prospectively analyzed. Furthermore, 1 patient who failed hemostasis with suture-mediated VCD had successful hemostasis with fluoroscopic DOT technique as dry postclosure after balloon aortic valvuloplasty. Results: In total, 50 patients were analyzed with a mean age of 81 years and majority were male (56%). Majority had comorbidities of hypertension (88%) and hyperlipidemia (94%), 24% had peripheral arterial disease, 38% coronary artery disease, and 58% were former smokers. Importantly, 40% were obese with an average body mass index (BMI) of 29 kg/m2. There were no bleeding or ischemic limb complications post MANTA VCD deployment using the fluoroscopic DOT technique. Furthermore, none of the patients required peripheral intervention from index procedure to 1 month post verified during their 1-month post TAVR follow-up. Conclusion: Fluoroscopic DOT technique using the MANTA VCD is highly reproducible and allows hemostasis in a predictable manner for procedures requiring large-bore arterial access in the absence of MANTA depth measurement.

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Impact of High Body Mass Index on Vascular and Bleeding Complications After Transcatheter Aortic Valve Implantation

Cited by 16 publications

References 31 publications

Impact of ABO Blood Group on Thromboembolic and Bleeding Complications in Patients with Left Ventricular Assist Devices

Impact of ABO Blood Group on Thromboembolic and Bleeding Complications in Patients with Left Ventricular Assist Devices

Prognostic value of the dynamic hepatorenal function on intermediate‐term mortality in TAVI patients with survival to discharge

Alternative Application Technique for the MANTA Vascular Closure Device for Percutaneous Large-Bore Arterial Access Closure: The Fluoroscopic DOT Technique

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