Incidence and risk factors of hemolysis after transcatheter aortic valve implantation with a balloon-expandable valve

Authors: Laflamme, JérômePuri, RishiUrena Alcazar, MarinaLaflamme, LouisDeLarochellière, HugoAbdul-Jawad Altisent, OmarDel Trigo, MariaCampelo-Parada, FranciscoDeLarochellière, RobertParadis, Jean-MichelDumont, ÉricDoyle, DanielMohammadi, SiamakCôté, MélaniePibarot, PhilippeLaroche, VincentRodés-Cabau, Josep
Abstract: There are currently no data evaluating the hematologic and biocompatibility profile of transcatheter aortic valves in vivo. We evaluated the incidence, predictive factors, and clinical consequences associated with hemolysis post-transcatheter aortic valve implantation (TAVI). A total of 122 patients who underwent TAVI with a balloon-expandable valve were included. Baseline blood sampling and echocardiography, followed by early post-TAVI echocardiography and repeat blood sampling, at 6 to 12 months post-TAVI were performed. Hemolysis post-TAVI was defined according to the established criteria. The incidence of hemolysis post-TAVI was 14.8% yet no patient experienced severe hemolytic anemia requiring transfusion. Compared with the nonhemolysis group, those with hemolysis demonstrated significant reductions in hemoglobin (p = 0.012), were more frequently women (67% vs 34%, p = 0.016), and had a higher incidence of post-TAVI severe prosthesis-patient mismatch (PPM) (44% vs 17%, p = 0.026). The rate of mild or more prosthetic valve regurgitation did not significantly differ between those patients with and without hemolysis (56% vs 37%, p = 0.44). Wall shear rate (WSR) and energy loss index (ELI), both indirect measures of shear stress, were higher (p = 0.039) and lower (p = 0.004), respectively, in those patients with hemolysis. Increasing PPM severity was also associated with significant stepwise WSR increments and ELI decrements (p <0.01 for both). In conclusion, subclinical hemolysis occurred in 15% of patients following TAVI. Although prosthetic valve regurgitation had no impact on hemolysis, a novel association between PPM and hemolysis was found, likely driven by higher shear stress as determined by WSR and ELI. These hematologic and biomechanical findings may have long-term clinical implications and could affect future transcatheter aortic valve design.
Document Type: Article de recherche
Issue Date: 1 June 2015
Open Access Date: Restricted access
Document version: VoR
This document was published in: The American journal of cardiology, Vol. 115 (11), 1574–1579 (2015)
Alternative version: 10.1016/j.amjcard.2015.02.059
Collection:Articles publiés dans des revues avec comité de lecture

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