Risk of recurrent gastrointestinal bleeding after aortic valve replacement in patients with Heyde syndrome

Objective: We sought to evaluate the effectiveness of aortic valve replacement for reducing gastrointestinal bleeding in patients with Heyde syndrome, in whom gastrointestinal bleeding is associated with intestinal angiodysplasia and aortic valve stenosis.

Methods: We conducted a retrospective review of patients treated at the Mayo Clinic between 1971 and 2007 for gastrointestinal bleeding and intestinal angiodysplasia who later underwent aortic valve replacement for severe aortic valve stenosis. We analyzed early and late outcomes, including recurrent gastrointestinal hemorrhage.

Results: Fifty-seven patients (39 men and 18 women) were identified. At operation, the median age of patients was 75 years. Intestinal angiodysplasia occurred most commonly in the duodenum and right side of the colon. Before aortic valve replacement, the mean number of bleeding episodes was 12 per patient-year; 48 patients (84%) required blood transfusions. Bioprosthetic valves were used in 47 patients. During follow-up extending to 15 years, 45 patients (79%) had no recurrence of bleeding. In patients who experienced recurrent bleeding, the episodes were reduced from a mean ± standard deviation of 4.7 ± 7 episodes per patient-year to 1.9 ± 2 per patient-year. Recurrent bleeding occurred only in patients with lesions of the duodenum or right colon. Among patients who received bioprostheses, the overall risk of recurrent bleeding was 15%, lower than the 50% risk of subsequent gastrointestinal bleeding with mechanical prostheses.

Conclusions: Aortic valve replacement seems to decrease the risk of gastrointestinal bleeding in patients with Heyde syndrome and is curative in approximately 80%. Although rates of recurrent bleeding were not significantly different between the 2 prosthetic valve types, the higher risk of bleeding in patients receiving warfarin makes bioprosthetic valves the valve of choice for most patients.