Clinical InvestigationValvular and Congenital Heart DiseaseAdverse impact of bleeding and transfusion on the outcome post-transcatheter aortic valve implantation: Insights from the Pooled-RotterdAm-Milano-Toulouse In Collaboration Plus (PRAGMATIC Plus) initiative
Section snippets
PRAGMATIC initiative
The PRAGMATIC Plus initiative is a collaboration of four European centers with established TAVI experience. Baseline patient characteristics, procedural details, and clinical outcome data from a series of 943 consecutive patients who underwent TAVI were collected from November 2005 to August 2011: San Raffaele Scientific Institute, Milan (n = 330); Clinique Pasteur, Toulouse (n = 224); Thoraxcenter, Erasmus Medical Center, Rotterdam (n = 206); Hôpital Rangueil, Toulouse (n = 184). After the
Study population
The baseline characteristics of the overall study population and the subgroups dichotomized by need for RBC transfusion are listed in Table I. Among the 943 patients analyzed, 53.8% were men. The mean logistic EuroScore was 20.9%; 28.3% of the patients were diabetics; 62.9% had renal failure; 45.1% had coronary artery disease; 34.4% had chronic obstructive pulmonary disease; and 17% had left ventricle ejection fraction ≤35%. Patients in the RBC cohort were more often females (54.5 vs 41%, P <
Discussion
The PRAGMATIC Plus Initiative is one of the largest series of patients treated with transcatheter aortic valve implantation reporting on blood transfusion and its impact on clinical outcome.
VARC bleeding was frequent. More than one third of the study population experienced life-threatening or major bleeding. The most frequent cause of bleeding was vascular complication (23.2%). This vascular complication rate is higher than findings from Gurvitch et al (17.4%) or Nuis et al (16%).14, 15 The
Conclusion
Bleeding is frequent after TAVI and is mainly driven by vascular complications. Red blood cells transfusion is associated with an increased mortality at 1 year and an increased risk of major stroke and acute kidney injury. Specific scores are needed to identify the patients at higher risk of TAVI-related bleeding and RBC transfusion.
Disclosures
Conflicts of interest: Didier Tchetche, Nicolas Dumonteil and Bertrand Marcheix are proctors for Edwards and Medtronic. Peter P.T. De Jaegere is proctor for Medtronic.
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2022, Hellenic Journal of CardiologyCitation Excerpt :The main results of this retrospective research are as follows: 1) although amelioration of hemodynamic profile was achieved through both approaches, BE-RDVs exhibited better performance because an amelioration of PVL in the immediate postprocedural period, and an amelioration in transprosthetic pressure gradients, iEOA, and EFVR at six-month follow-up; 2) the prostheses hemodynamics was clearly linked to their size, indeed, hemodynamic advantage in the BE-RDV group was greater among those patients with smaller aortic annulus; and 3) despite their worse baseline echocardiographic profile, patients implanted with BE-THVs exhibited a greater amelioration in LVEF, PASP, and tricuspid regurgitation at mid-term follow-up. Patients undergoing both TAVI and SAVR are exposed to an ineluctable risk for postprocedural bleeding and transfusion33,34. In particular, our study showed that major bleedings were 8-to-9 times more frequent in the SAVR group than in the TAVI one.
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