Left-Sided Prosthetic Valve Dysfunction and Gastrointestinal Bleeding Short Title: Prosthetic Valve Dysfunction and GI Bleeding

The association between left-sided prosthetic valve (PV) dysfunction and gastrointestinal (GI) bleeding is not well established. In a retrospective cohort of patients with left-sided prostheses, we identified those who experienced one or more GI bleeds. The latest or chronologically closest echocardiogram to the GI bleed was analyzed by a blinded investigator for PV dysfunction. Among 334 unique patients, 166 had aortic prostheses, 127 had mitral prostheses, and 41 had both. A total of 58 (17.4%) subjects had GI bleeding events. Patients in the “GI Bleed” group had higher mean ejection fraction (56 ± 14% vs. 49 ± 15%; P = 0.003) and higher prevalence of hypertension, end-stage renal disease, and liver cirrhosis compared to the “No GI Bleed” group. There was a higher prevalence of moderate or severe PV regurgitation in the GI Bleed vs. No GI Bleed group (8.6% vs. 2.2%; P = 0.027). Moderate or severe prosthetic valve regurgitation was independently associated with GI bleeding (odds ratio, 6.18; 95% confidence interval, 1.27–30.05; P = 0.024), after adjusting for ejection fraction, hypertension, end-stage renal disease and liver cirrhosis. Paravalvular regurgitation was associated with a higher incidence of GI bleeding compared to transvalvular regurgitation (35.7% vs. 11.9%; P = 0.044). The prevalence of PV stenosis was similar between the GI Bleed and No GI Bleed groups (6.9% vs. 5.8%; P = 0.761). In conclusion, among patients with predominantly surgically placed PV, moderate to severe left-sided PV regurgitation was independently associated with GI bleeding. PV stenosis was not associated with GI bleeding.