Analysis of cardiovascular mortality, bleeding, vascular and cerebrovascular events in patients with atrial fibrillation vs. sinus rhythm undergoing transfemoral Transcatheter Aortic Valve Implantation (TAVR)

Abstract

BackgroundTranscatheter aortic valve replacement (TAVR) has been demonstrated to be an established therapy for high-risk, inoperable patients with severe symptomatic aortic valve stenosis. For patients with moderate surgical risk, TAVR is equivalent to conventional aortic valve surgery. However, atrial fibrillation (AF) is also present in many of these patients, thus requiring post-implantation oral anticoagulation therapy in addition to the inhibition of thrombocyte aggregation, which poses the risk of bleeding complications. The aim of our work was to investigate the influence of AF on mortality and the occurrence of bleeding, vascular and cerebrovascular complications related to TAVR according to the VARC-2 criteria.MethodsTwo hundred eighty-three patients who underwent TAVR between March 2010 and April 2016 were retrospectively examined. In total, 257 patients who underwent transfemoral access were included in this study. The mean patient age was 81 ± 6 years, 54.1% of the patients were women, and 42.4% had pre-interventional AF.ResultsCompared to patients with sinus rhythm (SR, n = 148), patients with AF (n = 109) had an almost three-fold higher incidence of major vascular complications (AF 14.7% vs. SR 5.4%, p = 0.016) and life-threatening bleeding (AF 11.9% vs. SR 4.1%, p = 0.028) during the first 30 post-procedural days. However, the rate of cerebrovascular complications (AF 3.7% vs. SR 2.7%, p = 0.726) did not significantly differ between the two groups. Overall mortality was significantly higher in patients with AF during the first month (AF 8.3% vs. SR 2.0%, p = 0.032) and the first year (AF 28.4% vs. SR 15.3%; p = 0.020) following TAVR.ConclusionPatients with AF had significantly more severe bleeding complications after TAVR, which were significantly related to mortality. Future prospective randomized studies must clarify the optimal anticoagulation therapy for patients with AF after TAVR.Trial registration DRKS00011798 on DRKS (Date 17.03.2017).

Das moderne befund- und patientenadaptierte Management von peripheren Pseudoaneurysmen nach arteriellem Zugang

“…Meist können auch kleinere PSAs der A. radialis, A. brachialis oder A. carotis durch Thrombininjektion verschlossen werden [7,43]. Auch die zunehmende Zahl an kathetergestützten Herzklappenimplantationen führt zu einer wachsenden Anzahl an Gefäßkomplikationen [52,53]. Da es sich bei diesen Patienten teils um kardiopulmonal-/zirkulatorisch-funktionell inoperable Patienten handelt, stellt hier die Thrombininjektion in der Sanierung der PSA oftmals eine gute Wahl dar.…”

A Review of the Incidence and Management of New-Onset Atrial Fibrillation Post Transcatheter Aortic Valve Implantation

“…While TAVI is becoming a more popular treatment option, the 5-year mortality can be as high as 59.1% with predictors including atrial fibrillation (AF) and access route for TAVI [4]. AF is common in high-risk patients with severe aortic stenosis and is associated with an increased risk of bleeding complications and all-cause mortality [5][6][7].…”