ENDOSCOPIC RESOLUTION OF ANGIODYSPLASIAS FOLLOWING TRANSCATHETER AORTIC VALVE IMPLANTATION IN HEYDE SYNDROME: A PROSPECTIVE COHORT STUDY

Background and aims: Heyde syndrome is the co-occurrence of aortic stenosis and gastrointestinal bleeding secondary to angiodysplasias. Several studies have demonstrated cessation of gastrointestinal bleeding after transcatheter aortic valve implantation (TAVI), but the fate of angiodysplasias is largely unknown. This study aimed to establish the effects of TAVI on gastrointestinal angiodysplasias and identify the factors associated with recovery.

Methods: In this prospective, single-center cohort study, patients who were on the TAVI waitlist and had anemia were assessed by capsule endoscopy. Those with angiodysplasias were reassessed six months after undergoing TAVI. Endoscopic images were anonymized and evaluated by two independent researchers using an advanced artificial intelligence solution.

Results: Twenty-four patients underwent capsule endoscopy, and angiodysplasias were present in 18 of them (prevalence 75%). TAVI was performed in 15/18 patients with angiodysplasias, of which 11 agreed to a second capsule endoscopy. The mean number of vascular lesions decreased from 6.4±5.6 to 2.0±2.1 (p=.036). Vascular lesions decreased in 9/11 (82%) patients, including 6/11 (55%) who no longer had any angiodysplasias. Resolution of angiodysplasias was less frequent in patients with multiple valvular heart disease before TAVI (0/3 [0%] vs 6/8 [75%]) and patients with significant paravalvular leakage after TAVI (2/5 [40%] vs 4/6 [67%]).

Conclusion: Angiodysplasia-related bleeding is the likely cause of anemia in patients with aortic stenosis, and TAVI is an effective form of treatment. Resolution of angiodysplasias was less frequent in patients with remaining valvular heart disease.