Impact of bleeding complications after transcatheter mitral valve repair. (February 2021)

• Record Type: Journal Article
• Authors: Paukovitsch, Michael; Schepperle, Niklas; Pott, Alexander; Buckert, Dominik; Moritz Schneider, Leonhard; Keßler, Mirjam; Reichart, Christine; Rottbauer, Wolfgang; Markovic, Sinisa
• Is Part Of: IJC heart & vasculature. Volume 32(2021)
• Publication Date: 2021-02
• Subjects: TMVr -- Complications -- Bleeding -- Survival -- Chronic kidney disease; TMVr Transcatheter Mitral Valve Repair -- MC MitraClip -- MVARC Mitral Valve Academic Research Council -- CKD Chronic Kidney Disease -- AKI Acute Kidney Injury -- NOAC Novel oral anticoagulant -- HAS-BLED Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (>65 years), Drugs/Alcohol ATRIA, Anticoagulation and Risk factors In Atrial fibrillation -- ORBIT Outcomes Registry for Better Informed Treatment of Atrial Fibrillation; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Pathophysiology -- Periodicals; 616.1005
• DOI: 10.1016/j.ijcha.2020.100707
• Languages: English
• ISSNs: 2352-9067

Abstract

Highlights: Almost half of bleedings after TMVr were related to the vascular access site. None of the bleeding sites investigated in this study were independently associated with increased mortality. The ORBIT score performs best and should be calculated to identify patients at high risk for any MVARC bleeding. Abstract: Background: Bleeding in the context of cardiac catheterization is frequent and negatively impacts on short- and long-term patient outcome. We evaluated the clinical impact of in-hospital bleeding events after transcatheter mitral valve repair (TMVr) in the long-term follow- up. Methods: 586 consecutive patients treated with first-time TMVr were enrolled in this registry. In-hospital MVARC (Mitral Valve Academic Research Council) bleedings were assessed and patients were grouped according to the incidence of a bleeding event. Multivariate logistic regression was used to identify significant independent predictors of MVARC bleeding. This study received approval by local ethics committee. Results: 78 patients (13.3%) suffered from an MVARC bleeding event (Access site-related bleedings: 46.2%; GI tract bleeding: 35.9%; Other bleedings: 17.9%). Among these bleeding subgroups, neither relevant differences in baseline characteristics nor in severity of bleeding events were observed. Despite not being an independent predictor for overall death in the multivariate Cox regression analysis, MVARC bleeding was associated with prolonged hospital stay. The ORBIT bleeding score was the best match to predictors of any MVARC bleeding found in our cohort (c-score overall cohort: 0.68; c-score GI bleeding cohort: 0.72). Conclusion: MVARC bleedings after TMVr are frequent findings but were only in half of the cases related to the access site. The ORBIT score could be useful for identification of patients at high risk for non-access site bleeding and especially GI bleeding.