Frequency and Significance of Intravascular Hemolysis Before and After Transcatheter Aortic Valve Implantation in Patients With Severe Aortic Stenosis
Journal
The American journal of cardiology
Journal Volume
121
Journal Issue
1
Pages
69
Date Issued
2018-01-01
Author(s)
Abstract
Intravascular hemolysis (IVH) has been identified in patients with surgical prosthetic valves, but few have been reported after transcatheter aortic valve implantation (TAVI). We conducted a prospective analysis of 64 TAVI patients. The hemolysis profiles were collected at baseline and 6 months after TAVI. The echocardiography was performed at baseline and 6 months after TAVI. There are 14 patients (21.9%) with IVH before and 24(37.5%) after TAVI. The serum haptoglobin values before and 6 months after TAVI are 126.7 ± 75.1 vs 86.3 ± 57.1 mg/dl (p < 0.001). More ≥moderate paravalvular leakage (PVL) (50% vs 7.5%, p < 0.001), bicuspid aortic valve (BAV) (33.3% vs 5.0%, p = 0.004), use of 23 mm prosthesis (29.2% vs 7.5%, p = 0.03), higher residual valvular pressure gradient (17.9 ± 6.8 mm Hg vs 14.7 ± 5.7 mm Hg, p = 0.05), and lower effective orifice area index (1.05 ± 0.21 vs 1.21 ± 0.29, p = 0.03) were observed in patients with post-TAVI IVH. On multivariate regression analysis, BAV and ≥moderate PVL are independently related to post-TAVI IVH. With log-rank test, 1-year rates of readmission due to cardiovascular cause were significantly higher in patients with post-TAVI IVH (odds ratio 4.5; 95% confidence interval 1.3 to 15.6; p = 0.02), after adjusting age and gender. In conclusion, ≥moderate PVL and BAV are predictors of post-TAVI IVH, which is associated with increased cardiovascular readmission in 1-year follow-up.
Subjects
HIGH-RISK PATIENTS; REPLACEMENT; PROSTHESIS; OUTCOMES; PERFORMANCE; ANEMIA
SDGs
Other Subjects
haptoglobin; haptoglobin; HP protein, human; adult; aged; aortic stenosis; Article; bicuspid aortic valve; cardiovascular disease; echocardiography; effective orifice area index; female; hemodynamic parameters; hospital readmission; human; intravascular hemolysis; major clinical study; male; mortality; paravalvular leak; priority journal; prosthesis size; residual valvular pressure gradient; transcatheter aortic valve implantation; aortic valve stenosis; blood; cohort analysis; complication; hemolysis; metabolism; middle aged; postoperative complication; prospective study; treatment outcome; very elderly; Aged; Aged, 80 and over; Aortic Valve Stenosis; Cohort Studies; Female; Haptoglobins; Hemolysis; Humans; Male; Middle Aged; Patient Readmission; Postoperative Complications; Prospective Studies; Transcatheter Aortic Valve Replacement; Treatment Outcome
Publisher
EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
Type
journal article