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

• Published in: The American journal of cardiology 2018-11, Vol.122 (10), p.1727-1731
• Main Authors: Iyengar, Amit, Sanaiha, Yas, Aguayo, Esteban, Seo, Young-Ji, Dobaria, Vishal, Toppen, William, Shemin, Richard J., Benharash, Peyman
• Format: Article
• Language: English
• Subjects: Age; Aged; Aged, 80 and over; Aortic valve; Aortic Valve - surgery; Aortic Valve Stenosis - surgery; Bleeding; Cardiovascular disease; Codes; Comorbidity; Complications; Coronary vessels; Databases, Factual; Demographics; Diabetes; Diagnosis related groups; DRGs; Female; Follow-Up Studies; Gastrointestinal Hemorrhage - diagnosis; Gastrointestinal Hemorrhage - epidemiology; Gastrointestinal Hemorrhage - etiology; Health risk assessment; Heart attacks; Heart failure; Heart Valve Prosthesis Implantation - adverse effects; Hospital Mortality - trends; Hospitals; Humans; Hypertension; Implantation; Incidence; Kidney diseases; Length of Stay - trends; Liver diseases; Lung diseases; Male; Morbidity; Mortality; Patient admissions; Patient Readmission - trends; Patients; Postoperative Hemorrhage - diagnosis; Postoperative Hemorrhage - epidemiology; Postoperative Hemorrhage - etiology; Propensity Score; Registries; Retrospective Studies; Risk Factors; Surgery; Survival Rate - trends; Time Factors; Transcatheter Aortic Valve Replacement - adverse effects; United States - epidemiology; Womens health
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2018.07.047

Improvements in technology and operator experience have led to exponential growth of transcatheter aortic valve implantation (TAVI) programs. Late bleeding complications were recently highlighted after TAVI with a high impact on morbidity. The purpose of the present study was to assess the incidence and financial impact of late Gastrointestinal (GI) bleeding after TAVI, and compare with the surgical cohort. Retrospective analysis of the National Readmissions Database was performed from January 2011 to December 2014, and patients who underwent TAVI or surgical aortic valve replacement (SAVR) were identified. Incidence of readmission with a diagnosis of GI bleeding was utilized as the primary end point. Overall, 43,357 patients were identified who underwent TAVI, whereas 310,013 patients underwent SAVR. Compared with SAVR, TAVI patients were older (81 vs 68y, p < 0.001), more women (48% vs 36%, p < 0.001), and had higher Elixhauser Comorbidity Index (6 vs 5, p < 0.001). Hospital stay was shorter with TAVI (5 vs 8 days, p < 0.001), but raw in-hospital mortality rates were similar (4.2% vs 3.8%, p = 0.022). In the TAVI cohort, 3.3% of patients were rehospitalized for GI bleeding compared with 1.5% of the SAVR cohort (p < 0.001). Average time to bleeding readmission was similar between cohorts (92 vs 84 days, p = 0.049). After multivariable adjustment, TAVI remained significantly associated with readmissions for GI bleeding compared with SAVR Adjusted Odds Ratio (AOR 1.54 [1.38 to 1.71], p < 0.001). In this national cohort study, TAVI was associated with more frequent readmissions for late GI bleeding compared with SAVR. In conclusion, strategies to reduce late GI bleeding may serve as important targets for improvement in overall quality of care.