Department of Gastroenterology and Hepatology (L.C.M.J.G., N.C.C.G., J.P.H.D., E.J.M.v.G.), Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Cardiology (M.J.P.R., M.H.v.W., K.v.d.W., N.v.R.), Radboud University Medical Center, Nijmegen, the Netherlands.
Circ Cardiovasc Interv. 2022 Jul;15(7):e011848. doi: 10.1161/CIRCINTERVENTIONS.122.011848. Epub 2022 Jul 5.
Heyde syndrome is the co-occurrence of aortic stenosis and gastrointestinal bleeding secondary to angiodysplasias. Surgical aortic valve replacement effectively reduces bleeding, but the effects of transcatheter aortic valve implantation (TAVI) are largely unknown. This study aimed to describe the reduction of gastrointestinal bleeding in patients with Heyde syndrome after TAVI and to identify the factors associated with rebleeding.
We enrolled patients with Heyde syndrome from a prospective TAVI registry. Gastrointestinal bleeding episodes were assessed by the Bleeding Academic Research Consortium classification, and cumulative incidence functions were used to calculate cessation rates. Factors potentially associated with rebleeding were analyzed using logistic regression. Differences between Heyde and non-Heyde patients were assessed through a case-cohort study.
Between December 2008 and June 2020, 1111 patients underwent TAVI. There were 70 patients with Heyde syndrome (6.3%). In the first year following TAVI, gastrointestinal bleeding ceased in 46 of 70 patients (62% [95% CI, 50%-74%]). Bleeding episodes decreased from 3.2 (95% CI, 2.5-4.2) to 1.6 ([95% CI, 1.2-2.2] =0.001) and hemoglobin levels increased from 10.3 (95% CI, 10.0-10.8) to 11.3 (95% CI, 10.8-11.6) g/dL (=0.007). Between 1 and 5 years after TAVI (35 [interquartile range, 21-51] months), 53 of 62 patients (83% [95% CI, 72%-92%]) no longer experienced gastrointestinal bleeding. Paravalvular leakage (≥mild) was associated with rebleeding risk (odds ratio, 3.65 [95% CI, 1.36-9.80]; =0.010). Periprocedural bleeding was more common in Heyde than in control patients (adjusted odds ratio, 2.55 [95% CI, 1.37-4.73]; =0.003).
Patients with Heyde syndrome are at increased risk for periprocedural bleeding. Post-TAVI, gastrointestinal bleeding disappears in the majority of patients. Paravalvular leakage may curtail these clinical benefits.
Heyde 综合征是指主动脉瓣狭窄和由血管发育不良引起的胃肠道出血同时存在。主动脉瓣置换术可有效减少出血，但经导管主动脉瓣植入术（TAVI）的效果在很大程度上仍未知。本研究旨在描述 Heyde 综合征患者 TAVI 后胃肠道出血减少的情况，并确定与再出血相关的因素。
我们从前瞻性 TAVI 注册研究中纳入了 Heyde 综合征患者。胃肠道出血事件采用 Bleeding Academic Research Consortium 分类进行评估，并使用累积发生率函数计算出血停止率。使用逻辑回归分析可能与再出血相关的因素。通过病例对照研究评估 Heyde 患者和非 Heyde 患者之间的差异。
2008 年 12 月至 2020 年 6 月，共 1111 例患者接受了 TAVI。其中 70 例患者患有 Heyde 综合征（6.3%）。TAVI 后 1 年内，70 例患者中有 46 例（62%[95%CI，50%-74%]）胃肠道出血停止。出血事件从 3.2（95%CI，2.5-4.2）降至 1.6（95%CI，1.2-2.2）（=0.001），血红蛋白水平从 10.3（95%CI，10.0-10.8）升至 11.3（95%CI，10.8-11.6）g/dL（=0.007）。TAVI 后 1 至 5 年（35[四分位距，21-51]个月），62 例患者中有 53 例（83%[95%CI，72%-92%]）不再发生胃肠道出血。瓣周漏（≥轻度）与再出血风险相关（比值比，3.65[95%CI，1.36-9.80]；=0.010）。Heyde 患者围手术期出血比对照组更常见（校正比值比，2.55[95%CI，1.37-4.73]；=0.003）。
患有 Heyde 综合征的患者围手术期出血风险增加。TAVI 后，大多数患者的胃肠道出血消失。瓣周漏可能会减少这些临床获益。
Zotero 插件
