BACKGROUND: Severe aortic stenosis is associated with acquired Von Willebrand deficiency (vWD) manifesting with recurrent gastrointestinal bleed (GIB) if left untreated. Few small studies have shown decreased incidence of GIB after surgical aortic valve replacement (SAVR) but limited data are available with transcatheter aortic valve replacement (TAVR). We sought to investigate the effect of TAVR on GIB in patients with severe aortic stenosis.
METHODS: Comprehensive retrospective analysis of 654 TAVR patients at a large tertiary care center from May 2011 to April 2016. Each patient was screened for the number of major and minor GIB one year prior to valve replacement and followed for the incidence of recurrent GIB post valve replacement.
RESULTS: 69 of 654 patients (10.6%) undergoing TAVR had GIB before valve replacement. CoreValve (MedTronic, Minneapolis, Minn.) was used in 72% and Evolut (Medtronic) 28%. Mean age was 82 (+ or - 7.9 years and 45% were women. The mean STS score was 9.2, deemed high risk. 76.7% of the patients with GIB before valve replacement had at least one major bleeding episode. Median follow-up was 12.3 months. Of all patients with GIB before valve replacement only 4 (5.5%) had recurrent GIB post valve replacement. There was no difference in the use of antiplatelets before vs. after valve replacement (92.7% vs. 97.2%); long-term anticoagulation (37.1% vs 45.2%); or proton pump inhibitors (61% vs. 72.6 % respectively); p>0.05. Angiodysplasia was found in 14 patients (20%), 1 of whom had recurrent GIB post TAVR.
CONCLUSION: Among patients with severe aortic stenosis who have gastrointestinal bleeding, the risk of recurrent bleed is only 5.5% after treatment with TAVR. This reduction in GIB occurs despite no significant change in use of antiplatelets, anticoagulants or proton pump inhibitors.
Ullah R, Abdul MKM, Odeh K, et al. TCT-717 Transcatheter Aortic Valve Replacement Reduces Major Recurrent Gastrointestinal Bleed in Severe Aortic Stenosis. Journal of the American College of Cardiology. 2016;68(18). doi:10.1016/j.jacc.2016.09.130.