Association between red blood cell transfusions and adverse effects after transcatheter aortic valve replacement- a meta analysis

Abstract

Funding Acknowledgements Type of funding sources: None. Background-Transcatheter aortic valve replacement (TAVR) is associated with periprocedural bleeding , mainly driven by vascular complications leading to blood cell transfusion. Additionally, anemia is highly prevalent in this population. The decision regarding the necessity for blood transfusion in patients undergoing TAVR is challenging. Methods-Electronic databases (Medline, Embase, Scopus, Cochrane) were searched from inception to December 16th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p < 0.05.The primary outcomes of interest were all-cause mortality, myocardial infarction(MI), Stroke(CVA), and acute kidney injury(AKI). Results- A total of six studies with 6701 participants (Transfusions = 1505, Non-Transfusions = 5196) were included in our analysis. Average follow-up duration was 30 days. Mean age was 82.4 and 81.5 in the Transfusions and Non-transfusions group respectively. RBC transfusion was associated with higher 30-day mortality (OR-4.08; 95%CI 2.29-7.27; p < 0.00001; I2 = 77) as well as increased risk of acute kidney injury (AKI) (OR 2.97;95%CI 2.07-4.26; p < 0.00001; I2 = 77) and stroke (OR 2.44; 95%CI 1.78- 3.34; p < 0.00001,I2 = 0) However, there was no significant difference in the incidence of MI (OR 1.15;95%CI 0.50-2.64; p = 0.74,I2 = 0) Conclusion- RBC transfusion is a correlate and an independent predictor of all-cause mortality, acute kidney injury and stroke in this patient population and should be used with caution Abstract Figure.