Frailty and Bleeding: Impact on Aortic Valve Replacement

Courtesy of Dr. Carlos Fava.

We are well aware that both transcatheter aortic valve replacement (TAVR) and surgical valve replacement (SAVR) generate bleeding (15% to 22% for TAVR and 22% to 44% for SAVR). 

Frail patients constitute a particular group. These have not yet been assessed as to the real risk they run and mortality with each of these strategies. 

A sub-analysis of the FRAILTY-AVR was carried out, including 1,195 frail patients. 747 received TAVR and 448 received SAVR (238 patients were combined with CABG) presenting major or life-threatening bleeding vs. patients who did not receive either of these. 

Mean age was higher in TAVR patients (83 vs. 77 years) as was STS: 6.1 vs. 3.4.

TAVR patients presented less life-threatening bleeding (3% vs. 8%), major bleeding with clinically apparent source (6% vs. 10%) and major bleeding without clinically apparent source (9% vs. 31%). In addition, they have less need for transfusion (0.9 vs. 2.8 units). Patients undergoing concomitant CABG presented higher bleeding rate. 

Read also: Antiaggregation vs. Anticoagulation after Peripheral PCI.

Mortality at 30 days was higher in patients presenting bleeding with both strategies. 

At one year follow-up, major bleeding was associated to a three-fold increase in mortality, both for TAVR (36% vs. 14% odds ratio: 3.40; 95% confidence interval: 2.22 to 5.21) and SAVR (11% vs. 4% odds ratio: 2.79; 95% confidence interval: 1.25 to 6.21).

Conclusion

Frailty is associated to post-procedural major bleeding in elderly adults undergoing TAVR or SAVR, ad with higher mid-term mortality. 

Courtesy of Dr. Carlos Fava.

Original Title: Frailty and Bleeding in Older Adults Undergoing TAVR or SAVR Insights From the FRAILTY-AVR Study.

Reference: Melissa Bendayan, et al. J Am Coll Cardiol Intv 2020;13:1058–68.

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