• Giuseppe Tarantini, Marco Mojoli, Alberto Barioli, Michele Battistel, and Philippe Généreux.
• Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, Padua, Italy. Electronic address: giuseppe.tarantini.1@gmail.com.
• Int. J. Cardiol. 2016 Dec 1; 224: 107-111.

BackgroundPost-procedure non-access site-related bleedings have a significant impact on mortality in patients treated by transcatheter aortic valve replacement (TAVR). Notwithstanding, the source of these bleedings is frequently indeterminate, with potentially serious clinical implications related to lack of diagnosis and treatment.MethodsOut of 513 TAVR performed between June 2007 and January 2016 in the Interventional Cardiology Laboratory of the Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, we identified few proven cases of concealed bleeding after TAVR due to blood oozing.ResultsWe report three cases of angiographically confirmed post-TAVR non-access bleedings related to spontaneous blood oozing, a life-threatening condition consisting of diffuse capillary hemorrhage developing from vessels not directly involved by the procedure. We hypothesize that spontaneous post-procedural blood oozing may account for a substantial proportion of non-overt, non-access site-related bleeding after TAVR.ConclusionThe possibility of post-TAVR blood oozing is largely neglected in the literature, and comprehensive categorization of non-access site bleedings in current standardized endpoints of TAVR studies is missing. Early assessment with arterial and venous contrast phase angio-MDCT scans in case of post-TAVR unexplained and persistent anemia may allow diagnosis and treatment of this subtle condition.Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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