Association Between Blood Transfusions and 12-Month Mortality After Transcatheter Aortic Valve Implantation

Abstract

SummaryBlood transfusions are considered as an important predictor of adverse outcome in patients with severe aortic (AS) undergoing transcatheter aortic valve implantation (TAVI). We sought to investigate the association between blood transfusions and mortality after TAVI. We enrolled 101 consecutive patients with severe AS undergoing TAVI. Patients who required transfusion were defined as patients in whom at least one unit of packed red blood cells (PRBCs) was transfused in the perioperative period. Twelve-month outcomes were assessed based on Valve Academic Research Consortium definitions. A total of 28 (27.7%) patients required blood transfusion after TAVI. Baseline characteristics of the patients with and without a transfusion were similar. Median amount of PRBCs was 2 (interquartile range, 2-4). Twelvemonth all-cause mortality was higher in patients with than without a blood transfusion (39.3% versus 9.6%; P = 0.001). Importantly, the need for a blood transfusion after TAVI was an independent predictor of higher mortality rates after 12 months (hazard ratio (HR) 2.84 95%CI (1.06-7.63); P = 0.039; (HR for incomplete coronary revascularization 10.86, 95%CI 3.72-31.73; P < 0.001; HR for a history of stroke/TIA 3.93, 95%CI 1.39-11.07; P < 0.001). The duration of inhospital stay was longer in patients requiring transfusion (16.0 (14.0-22.0) versus 7.0 (7.0-11.5) days; P = 0.014). In conclusion, blood transfusions after TAVI were associated with higher mortality rates after 12 months, longer in-hospital stay, and were identified as an independent predictor of impaired clinical outcome. (Int Heart J 2017; 58: 50-55)

Early Safety and Efficacy of Transcatheter Aortic Valve Implantation for Asian Nonagenarians (from KMH Registry)

“…90 and < 90 years had a low rate of bleeding according to VARC-2 criteria. Previous studies showed that serious bleeding events 24) and blood transfusions 25) were associated with higher 1-year mortality. This point may also reflect high survival rates after TAVI among our population.…”

Trends and outcomes of red blood cell transfusion in patients undergoing transcatheter aortic valve replacement in the United States

“…Prior single-center studies have demonstrated similar associations among blood transfusion and increased 30-day and 1-year mortality in patients undergoing TAVR. 8,23,24 Whether the increased mortality in TAVR patients receiving RBC transfusion is related to baseline anemia, bleeding, or transfusion itself is unclear. In our study, the propensity-matched cohort was well balanced on all baseline characteristics, including anemia (standardized difference, 8.2%), thereby minimizing any potential confounding effect of anemia on the association between RBC transfusion and mortality.…”

Valve Hemodynamics and Clinical Outcomes After Transcatheter Aortic Valve Replacement for a Small Aortic Annulus

“…28) The difference in bleeding following TAVR and SAVR was not assessed. [29][30][31] Fourth, aortic annular enlargement or root replacement was not performed in our elderly cohort, although some reports have demonstrated efficacy in young patients. 3,32,33) The indication of these procedures should be discussed on a case-by-case basis as the adjunctive procedure could make the surgery more complex.…”