Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Am J Cardiol. 2022 Aug 15;177:76-83. doi: 10.1016/j.amjcard.2022.04.053. Epub 2022 Jun 28.
To investigate the effectiveness of transcatheter aortic valve implantation (TAVI) for resolving gastrointestinal bleeding (GIB) in patients with severe GIB and severe aortic stenosis. This was an observational study of consecutive TAVI procedures from 2011 to 2018, identified through a prospectively maintained institutional database. Patients with severe GIB defined as abnormal hemoglobin/hematocrit and overt bleeding or positive fecal occult blood test. Groups were compared for differences in baseline clinical and procedural characteristics and post-TAVI outcomes. A total of 1,192 patients who underwent TAVI were identified, of which 164 patients (13.8%) were found to have had severe GIB. Society of Thoracic Surgeons-Predicted Risk of Mortality scores were higher in the severe GIB group than in the non-GIB group (8.8 ± 5.3 vs 7.6 ± 4.5, p = 0.002). The 30-day mortality was similar across each group (p >0.05), with overall 30-day mortality being 3.2% (38 of 1,192) for the entire cohort. Of the 164 TAVIs with severe GIB, 130 (79.3%) had resolution of their GIB after their TAVI. Patients without resolution of their GIB had higher aortic valve mean pressure gradients after their TAVI (15.0 ± 5.3 vs 9.0 ± 4.3). In conclusion, TAVI was associated with substantial reductions in severe GIB. Despite higher baseline risk, patients with severe GIB achieved similar outcomes, including 30-day mortality, compared with patients without GIB. TAVI may be a safe and effective treatment for patients with severe aortic stenosis and severe GIB, whereas persistently high transvalvular pressure gradients after TAVI may be related to the likelihood of recurrent GIB.
探讨经导管主动脉瓣植入术（TAVI）治疗严重胃肠道出血（GIB）合并严重主动脉瓣狭窄患者胃肠道出血的疗效。这是一项回顾性研究，纳入了 2011 年至 2018 年连续进行的 TAVI 手术，这些数据来自于一个前瞻性维护的机构数据库。严重 GIB 定义为血红蛋白/血细胞比容异常和显性出血或粪便潜血试验阳性。比较两组患者的基线临床和手术特征以及 TAVI 术后结局。共纳入 1192 例行 TAVI 的患者，其中 164 例（13.8%）患者存在严重 GIB。严重 GIB 组患者的胸外科医师协会预测死亡率评分高于无 GIB 组（8.8 ± 5.3 比 7.6 ± 4.5，p=0.002）。各组 30 天死亡率无差异（p＞0.05），整个队列的 30 天总死亡率为 3.2%（1192 例中的 38 例）。164 例严重 GIB 患者中，130 例（79.3%）TAVI 后 GIB 得到缓解。未缓解 GIB 的患者 TAVI 后主动脉瓣平均压力梯度更高（15.0 ± 5.3 比 9.0 ± 4.3）。总之，TAVI 可显著减少严重 GIB。尽管基线风险较高，但严重 GIB 患者与无 GIB 患者的结局相似，包括 30 天死亡率。TAVI 可能是治疗严重主动脉瓣狭窄和严重 GIB 患者的一种安全有效的方法，而 TAVI 后持续高跨瓣压力梯度可能与复发性 GIB 的可能性相关。
