Blood Transfusion and Outcome After Transfemoral Transcatheter Aortic Valve Replacement

Abstract

To investigate the prognostic impact of red blood cell (RBC) transfusion on the outcome after transfemoral transcatheter aortic valve replacement (TAVR). Design: Nationwide, retrospective multicenter study. Setting: Five University Hospitals. Participants: The nationwide FinnValve registry included data from 2,130 patients who underwent TAVR for aortic stenosis from 2008 to 2017. After excluding patients who underwent TAVR through nontransfemoral accesses, 1,818 patients were selected for this analysis. Intervention: TAVR with or without coronary revascularization. Measurements and Main Results: RBCs were transfused in 293 patients (16.1%). Time-trend analysis showed that the rates of RBC transfusion decreased significantly from 27.5% in 2012 to 10.0% in 2017 (p < 0.0001). Among 281 propensity score matched pairs, RBC transfusion was associated with higher 30-day mortality (7.1% v 0%, p < 0.0001), late mortality (at 5-year, 59.1% v 43.3%, p = 0.008), as well as increased risk of acute kidney injury (17.0% v 4.4%, p < 0.0001), renal replacement therapy (3.6% v 0.4, p < 0.0001) and prolonged hospital stay (mean, 8.5 v 4.7 days, p < 0.0001) compared with patients who did not receive blood transfusion. In the overall series, the risk of adverse events increased significantly with the increasing amount of transfused RBC units and when operation for excessive bleeding was necessary. Consistently with these

Impact of vascular complications after transcatheter aortic valve implantation. VASC‐OBSERVANT II sub‐study

“…The presence of major VC was also associated with an increased incidence of in‐hospital acute kidney disease, bleeding and longer hospital stay after index procedure. Indeed, the increased rate of bleeding and requirement of blood transfusion herein observed among patients with major VC might be a determinant of increased mortality of these patients 27 . Consistently with the literature, in our cohort, the sheath size did not influence VC in the setting of TAVI procedures performed with contemporary devices 28 …”

Impact of Major Vascular Complication Access Site Status on Mortality After Transfemoral Transcatheter Aortic Valve Replacement ― Results From the FinnValve Registry ―

“…In contrast, RBC transfusion itself is independently associated with early and late mortality after TAVR. 26 The transfusion-related immunomodulation leading to acute, and even chronic impairment of macrophage function 27 may partly explain the increase in mortality as the units of RBC transfusion increased in the present study. Unsurprisingly, female sex was associated with access site-related MVC.…”

A nomogram based on serum cystatin C for predicting acute kidney injury in patients with traumatic brain injury

“…RBC transfusion was also confirmed as a latent risk factor for developing AKI in some kinds of patients especially those undergoing cardiac surgery [61][62][63][64]. Therefore, incorporating lymphocyte count and RBC transfusion into the predictive nomogram may increase the accuracy and stability.…”