Blood oozing: A cause of life-threatening bleeding without overt source after transcatheter aortic valve replacement. (1st December 2016)

• Record Type: Journal Article
• Authors: Tarantini, Giuseppe; Mojoli, Marco; Barioli, Alberto; Battistel, Michele; Généreux, Philippe
• Is Part Of: International journal of cardiology. Volume 224(2016)
• Page Start: 107
• Page End: 111
• Publication Date: 2016-12-01
• Subjects: Interventional cardiology -- Transcatheter aortic valve replacement -- Non-access site bleeding; angio-MDCT multidetector computed tomography angiography -- TAVR transcatheter aortic valve replacement -- UFH unfractionated heparin -- VARC Valve Academic Research Consortium; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.09.009
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Post-procedure non-access site-related bleedings have a significant impact on mortality in patients treated by transcatheter aortic valve replacement (TAVR). Notwithstanding, the source of these bleedings is frequently indeterminate, with potentially serious clinical implications related to lack of diagnosis and treatment. Methods: Out of 513 TAVR performed between June 2007 and January 2016 in the Interventional Cardiology Laboratory of the Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, we identified few proven cases of concealed bleeding after TAVR due to blood oozing. Results: We report three cases of angiographically confirmed post-TAVR non-access bleedings related to spontaneous blood oozing, a life-threatening condition consisting of diffuse capillary hemorrhage developing from vessels not directly involved by the procedure. We hypothesize that spontaneous post-procedural blood oozing may account for a substantial proportion of non-overt, non-access site-related bleeding after TAVR. Conclusion: The possibility of post-TAVR blood oozing is largely neglected in the literature, and comprehensive categorization of non-access site bleedings in current standardized endpoints of TAVR studies is missing. Early assessment with arterial and venous contrast phase angio-MDCT scans in case of post-TAVR unexplained and persistent anemia may allow diagnosis and treatment of this subtle condition.