Transcatheter aortic valve implantation: what's the bleeding problem?

The importance of bleeding and its sequelae have been increasingly recognised by interventional cardiologists. We are undertaking increasingly complex percutaneous interventions, performed upon higher-risk patients, who are more elderly with a greater range of comorbidities,1 and using multiple anticoagulant pharmacotherapies,2 which may all increase susceptibility to bleeding. The advent of transcatheter aortic valve implantation (TAVI) has allowed cardiologists and surgeons to offer treatment for aortic valve disease to a similarly high-risk cohort of patients. The PARTNER randomised trial having demonstrated a survival benefit,3 the challenge is now to improve the safety profile of the procedure, and addressing the risk of bleeding is paramount to this. Borz et al 4 present data from a single centre using the Edwards bioprosthesis (Edwards Lifesciences, Irvine, California, USA). They report notable bleeding and life-threatening bleeding (LTB) rates of 27.6% and 13.2%, respectively. Their survival analysis confirmed the importance of LTB with a 36% absolute drop in 1-year …