OC 43.2 - Long-term reduction in blood transfusion incidence after correction of the shear-induced von Willebrand factor defect by TAVR-procedure

Monday, July 11, 2022

3:00 PM – 3:15 PM

Location: ExCel Center, ICC Capital Suite Room 7&12

Presentation Format: In-Person

Presenting Author(s)

AR

Antoine Rauch, MD, PhD

University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, France
Lille, Nord-Pas-de-Calais, France

Co-Author(s)

FV

Flavien Vincent

MD, PhD
CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France
Lille, Nord-Pas-de-Calais, France
TD

Tom Denimal

MD
CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France
Lille, Nord-Pas-de-Calais, France
HS

Hugues Spillemaeker

MD
CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France
Lille, Nord-Pas-de-Calais, France
TP

Thibault Pamart

MD
CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France
Lille, Nord-Pas-de-Calais, France
EJ

Emmanuelle Jeanpierre

PharmD
Lille University Hospital, Lille, France
Lille, Nord-Pas-de-Calais, France
MD

Maximilien Desvages

PharmD
Lille University, CHU, Department of Haematology, Lille, France
Lille, Nord-Pas-de-Calais, France
MD

Melanie Daniel

MD
Lille University, CHU, Department of Haematology and Clinical Haemostasis Unit, Lille, France
Lille, Nord-Pas-de-Calais, France
AD

Annabelle Dupont

Professor, PharmD, PhD
University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, France
Lille, Nord-Pas-de-Calais, France
EV

Eric Van Belle

MD,PHD
CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France
Lille, Nord-Pas-de-Calais, France
Sophie Susen, MD, PhD

Professor, MD, PhD
CRC-MHC, Lille University Hospital, Lille, France
Lille, Nord-Pas-de-Calais, France

Background: Aortic stenosis (AS) has been associated with an increased incidence of gastrointestinal (GI-) bleeding from angiodysplasia. The acquired Von Willebrand factor (VWF) high-molecular-weight (HMW) defect in AS-patients may account for this association. Whether trans-catheter aortic valve replacement (TAVR), allowing an immediate correction of the shear-induced VWF-defect, translates into a long-term reduction of blood transfusion is unknown.

Aims: To compare the long-term incidence of blood transfusion before and after TAVR-procedure.

Methods: We included 415 patients with severe-AS scheduled for TAVR in Lille University Hospital from 2010 to 2016 (WITAVI trial). All the transfusion events registered by the regional blood bank (Etablissement Français du Sang), in a period spanning the 5-years before and after TAVR-procedure, were first collected. After retrieving from medical records the events associated with bleeding, a Poisson regression model was used to compare blood transfusion incidence before and after TAVR-procedure, taking death as competing risk into account. VWF-HMW ratio and PFA-CADP were also measured before and at the end of TAVR-procedure.

Results: Mean age at inclusion was 81.9±7 and 200 patients died after TAVR (median follow-up = 3.4 years). Before TAVR, transfusion incidence progressively increased annually (from 0.03 in year-5 to 0.14 per-patient-year in year-1, p< 0.0001). At the time of TAVR, pre-procedural VWF HMW-ratio and PFA-CADP levels were significantly lower (both p< 0.0001) in patients with at least one pre-procedural transfusion. After TAVR allowing a within-day post-procedural correction of VWF-defect, a significant reduction in transfusion incidence was observed (RR = 0.53 [95%CI 0.38-0.72] compared to pre-procedural period), regardless of vital status at the end of follow-up (Table 1). After TAVR, the proportion of transfusion related to GI-bleeding also significantly decreased (p=0.006) and when the latter were explored endoscopically a ten-fold reduction in GI-angiodysplasia was observed (p < 0.0001).

Conclusion(s): TAVR is associated with a reduced incidence of blood transfusion and GI-bleeding from angiodysplasia.