Key result
High baseline valvular resistance linked to ~109% higher 1-year bleeding risk after TAVR.
Why the study?
Stenosis-induced shear stress affects platelet function and bleeding tendency, but the association between aortic valvular resistance and bleeding events in patients undergoing TAVR remained to be assessed.
Does high baseline valvular resistance increase the risk of bleeding events in patients undergoing TAVR?
Cohort (n=708)
Does high baseline valvular resistance increase the risk of bleeding events in patients undergoing TAVR?
High baseline valvular resistance is an independent predictor of early bleeding events following TAVR, likely reflecting shear stress-induced platelet dysfunction that resolves after stenosis relief.
May aid post-TAVR bleeding risk assessment; leaves open whether resistance-guided strategies warrant prospective testing.
Background Aortic valvular resistance (VR) may be a surrogate for shear stress in patients with aortic stenosis. Stenosis-induced shear stress is known to affect platelet function and bleeding tendency. The aim of this study is to assess the association between VR and bleeding events in patients undergoing transcatheter aortic valve replacement (TAVR). Methods VR was calculated in 708 patients undergoing TAVR between August 2007 and December 2015. All subjects were stratified into a high VR (HVR; ≥238 dynes·cm −5 ) and a low VR (LVR; <238) group according to the median of VR. The primary endpoint was bleeding within 1 year after TAVR. Results After adjustment for confounding factors, patients with HVR had a higher risk of bleeding events at 1 year (HR adj 2.09, 95% CI 1.56–2.80) than those with LVR. The difference emerged within the first month after intervention (HR adj 2.20, 95% CI 1.62–2.99) and was driven by procedural (HR adj 1.82, 95% CI 1.33–2.72) and non-procedural (HR adj 1.86, 95% CI 1.15–3.00) bleeding events. The effect was consistent across access sites and valve types. Of note, the unfavorable effect with regard to bleeding attenuated beyond 30 days post-TAVR (HR 1.01, 95% CI 0.32–3.14). In a multivariable analysis, HVR, renal failure at baseline, transapical approach, and moderate or greater post-TAVR aortic regurgitation were identified as independent predictors of bleeding within 1 year after TAVR. Conclusions HVR at baseline was associated with bleeding events after TAVR; however, bleeding tendency in this setting improved within 30 days after releasing stenosis at the aortic position. Abbreviations AR, aortic regurgitation; AS, aortic stenosis; AVA, aortic valve area; CI, confidence interval; MACCE, major adverse cardiac and cerebrovascular events; NYHA, New York Heart Association; RHC, right heart catheterization; TAVR, transcatheter aortic valve replacement; VARC, the Valve Academic Research Consortium; VR, valvular resistance
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Asami et al. (2019) conducted a cohort in Aortic stenosis in patients undergoing TAVR (n=708). High valvular resistance (≥238 dynes·cm⁻⁵) vs. Low valvular resistance (<238 dynes·cm⁻⁵) was evaluated on Bleeding within 1 year after TAVR (HR 2.09, 95% CI 1.56-2.80). High valvular resistance at baseline was associated with a higher risk of bleeding events at 1 year after TAVR compared to low valvular resistance (adjusted HR 2.09; 95% CI 1.56-2.80).
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