Incidence and prognostic implications of late bleeding events after percutaneous mitral valve repair

Abstract

ObjectivesMitraClip is an established therapy for patients with mitral regurgitation (MR) that are considered of high-risk or inoperable. However, late bleeding events (BE) after hospital discharge and their impact on prognosis in this cohort of patients have been poorly investigated. Our purpose is to address the incidence, related factors and clinical implications of BE after hospital discharge in patients treated with MitraClip.MethodsProspective registry of all consecutive patients (n = 80) who underwent MitraClip implantation in our Institution between June 2014 and December 2017. BE were defined according to MVARC definitions. A combined clinical end-point including admission for heart failure (HF) and all-cause mortality was established to analyze prognostic implications of BE.ResultsDuring a median follow up of 523.5 days, 41 BE were reported in 21 patients. Atrial fibrillation (AF, HR 4.54, CI95% 1.20–17.10) and combined antithrombotic therapy at discharge (HR 3.52, CI95% 1.03–11.34) were independently associated with BE. In the study period, 15 (18.8%) patients died, 20 (25%) were admitted for HF and 29 (36.3%) presented the combined end-point. After multivariable adjustment BE remained independently associated with an adverse outcome (HR 3.80, CI 95% 1.66–8.72). In the subgroup of patients with AF, HAS-BLED score was higher among subjects with BE (3.1 ± 1.3 vs 2.1 ± 0.9, p = 0.003). HAS-BLED score had a significant discrimination power for the occurrence BE (AUC: 0.677 [0.507–0.848]) in this subgroup.ConclusionsBE are common after MitraClip and are associated with an impaired outcome. Strategies to reduce bleeding events are paramount in this cohort of patients.

Thirty‐day readmissions after transcatheter versus surgical mitral valve repair in high‐risk patients with mitral regurgitation: Analysis of the 2014–2015 Nationwide readmissions databases

“…TMVR is performed via venous access, which typically is associated with lower bleeding complications compared with procedures requiring arterial access; however, there are limited contemporary data on rates of bleeding in patients undergoing TMVR. In our study one in four patients undergoing TMVR experienced a bleeding/transfusion event during the index hospitalization, which is similar to other recent investigations showing rates of 21–26% . Large‐bore venous access should be performed and managed as meticulously as arterial access to prevent access‐site bleeding complications.…”

Left-Sided Prosthetic Valve Dysfunction and Gastrointestinal Bleeding

“…A prior study has demonstrated a relationship between isolated mitral valve surgery including both mitral valve repair and replacement, and gastrointestinal bleeding [7]. A similar association of gastrointestinal bleeding has been reported in over 30% of patients after the implantation of MitraClip and it has been found to be the second most common cause of bleeding complications postprocedurally following access site-related bleeding [8,9].…”

“…Those whose echocardiogram reports suggested the presence of either mechanical or bioprosthetic prostheses, in the aortic or mitral positions were included in the study. The rationale for including patients with surgical or transcatheter mitral valve repair in our cohort is that the data indicates that there is an association between these types of repairs and GI bleeding events and acquired von Willebrand disease [7][8][9]. Electronic medical records of these patients were reviewed for demographic, clinical, laboratory, and echocardiographic data.…”