Tracking TAVR’s impact on gastrointestinal bleeding symptoms

Transcatheter aortic valve replacement (TAVR) is associated with significant reductions in gastrointestinal bleeding (GIB), according to new findings published in the American Journal of Cardiology. In fact, the authors added, short-term outcomes between patients with and without a history of GIB are quite similar.

Researchers tracked data from more than 1,100 TAVR patients treated at a single high-volume facility from 2011 to 2018. A total of 13.8% of those patients had severe GIB in addition to their severe aortic stenosis (AS)—a slightly higher percentage than some previous studies examining this same issue.

“This ought to remind cardiovascular specialists of the significant disease burden of GIB in the severe AS population, which continues to grow as patient age increases nationally,” wrote lead author James A. Brown MD, MS, of the University of Pittsburgh, and colleagues.

While Society of Thoracic Surgeons-Predicted Risk of Mortality scores were higher among GIB patients (8.8% vs. 7.6%), 30-day mortality was similar between the two groups. Also, GIB patients did have longer lengths of stay and a higher rate of acute kidney injury (AKI) than patients without GIB, but “other short-term outcomes were similar across each group, including stroke and vascular complications.”

“By implication, TAVR can be performed as safely for patients with GIB as patients without GIB; however, further research is required to reduce post-TAVR AKI in patients with GIB,” the authors wrote.

Brown et al. noted that patients who still required transfusions due to recurrent bleeding after TAVR had higher transvalvular pressure gradients. This, they wrote, backs up the idea that AS severity is related to a patient’s risk of GIB.