Heyde syndrome: prevalence and outcomes in patients undergoing transcatheter aortic valve implantation

Abstract

Background Heyde syndrome (HS) is known as the association of severe aortic stenosis (AS) and recurrent gastrointestinal bleeding (GIB) from angiodysplasia. Data on the prevalence of HS and results after TAVI remain scarce. Methods 2548 consecutive patients who underwent TAVI for the treatment of AS from 2008 to 2017 were evaluated for a history of GIB and the presence of HS. The diagnosis of HS was defined as a clinical triad of severe AS, a history of recurrent GIB, and an endoscopic diagnosis of angiodysplasia. These patients (Heyde) were followed to investigate clinical outcomes, bleeding complications and the recurrence of GIB and were compared to patients with GIB unrelated to HS (Non-Heyde). Results A history of GIB prior to TAVI was detected in 190 patients (7.5%). Among them, 47 patients were diagnosed with HS (1.8%). Heyde patients required blood transfusions more frequently compared to Non-Heyde patients during index hospitalization (50.0% vs. 31.9%, p = 0.03). Recurrent GIB was detected in 39.8% of Heyde compared to 21.2% of Non-Heyde patients one year after TAVI (p = 0.03). In patients diagnosed with HS and recurrent GIB after TAVI, the rate of residual ≥ mild paravalvular leakage (PVL) was higher compared to those without recurrent bleeding (73.3% vs. 38.1%, p = 0.05). Conclusion A relevant number of patients undergoing TAVI were diagnosed with HS. Recurrent GIB was detected in a significant number of Heyde patients during follow-up. A possible association with residual PVL requires further investigation to improve treatment options and outcomes in patients with HS. Graphic abstract

Reduction of Gastrointestinal Bleeding in Patients With Heyde Syndrome Undergoing Transcatheter Aortic Valve Implantation

“…prevalence is likely higher as small bowel assessment is not part of routine clinical workup in these patients. [4][5][6] Patients with Heyde syndrome have an increased bleeding risk, as high shear stress around the stenotic valve causes inordinate proteolysis of von Willebrand factor multimers. 7 This acquired form of von Willebrand disease combined with angiodysplasias results in a high requirement of blood transfusions, reduced quality of life, increased morbidity and mortality, and steep hospital costs.…”

“…4,13 Residual paravalvular leakage (PVL) after TAVI might contribute to rebleeding, but the effect size is unclear. 4,7 Lastly, the risk of periprocedural bleeding in Heyde patients is unknown.…”

“… 12 A recent study showed that gastrointestinal bleeding ceased completely in 40% of Heyde patients in the first year following valve implantation. 4 There are multiple outstanding questions. The extent and durability of the reduction in bleeding episodes and the concomitant rise in hemoglobin levels are unknown.…”

“…The extent and durability of the reduction in bleeding episodes and the concomitant rise in hemoglobin levels are unknown. 4 , 13 Residual paravalvular leakage (PVL) after TAVI might contribute to rebleeding, but the effect size is unclear. 4 , 7 Lastly, the risk of periprocedural bleeding in Heyde patients is unknown.…”

“… 4 , 13 Residual paravalvular leakage (PVL) after TAVI might contribute to rebleeding, but the effect size is unclear. 4 , 7 Lastly, the risk of periprocedural bleeding in Heyde patients is unknown. In the present study, we assessed the effect of TAVI on gastrointestinal bleeding in Heyde patients from a large prospective registry up to 5 years after the procedure and determined which factors are associated with rebleeding.…”