In patients with Heyde syndrome undergoing transcatheter aortic valve implantation, the average number of gastrointestinal vascular lesions dropped from 6.4 to 2.0 per patient within six months, according to a recent cohort study.

Researchers evaluated the impact of transcatheter aortic valve implantation (TAVI) on gastrointestinal (GI) angiodysplasia in patients with Heyde syndrome, defined by the coexistence of aortic stenosis (AS) and GI bleeding. Among 24 patients with severe AS and iron-deficiency anemia, 18 patients (75%) were diagnosed with GI vascular lesions, primarily angiodysplasias. TAVI was performed in 15 of these patients, and 11 agreed to undergo a second capsule endoscopy six months later.

Findings revealed a significant reduction in the mean number of vascular lesions per patient, from 6.4 to 2.0 (p = .04). A decrease in lesion count was observed in 82% of patients, with 55% achieving resolution of typical angiodysplasias. Additionally, angiogenesis markers, including vascular endothelial growth factor (VEGF) and angiopoietin-2, decreased significantly post-TAVI, suggesting a potential mechanism underlying the reduction in lesion count. These findings indicate that TAVI may offer benefits beyond AS management, potentially reducing GI bleeding risk associated with angiodysplasia in Heyde syndrome.

Published in JAMA Network Open, the study also identified factors associated with persistent angiodysplasia post-TAVI. Among patients with multiple valvular disease, none experienced complete resolution of lesions, while 75% of those with isolated AS saw improvement. Patients with paravalvular leakage post-TAVI were more likely to have persistent lesions, with 60% affected.

These findings suggest TAVI may provide a dual therapeutic benefit for patients with AS and GI angiodysplasias, though residual valvular pathology may limit efficacy. Furthermore, the decline in angiogenesis markers post-TAVI highlights a potential pathway for lesion reduction, meriting further investigation.

Full disclosures can be found in the published study.