Periprocedural transfusion in patients undergoing transfemoral transcatheter aortic valve implantation

Abstract

Transfusion was considered necessary in 14% (n = 243) of the patients. Female gender (OR [95% CI]) (1.680 [1.014-2.783]) and preprocedural moderate (7.594 [4.404-13.095]) and severe anemia (8.202 [0.900-74.752]) according to WHO were the most important preprocedural variables. Periprocedural, pericardial effusion (12.109 [3.753-39.063]), emergency extracorporeal circulation (54.5288 [6.178-481.259]) and major vascular injury (2.647 [1.412-4.962]) were related to transfusion. The same applies to moderate (4.255 [1.859-9.740]) and severe anemia (31.567 [8.560-116.416]) as well as periprocedural experience (0.072 [0.035-0.149] - 0.141[0.079-0.251], P < 0.001) CONCLUSION: Procedural experience, serious adverse events, low pre- and periprocedural Hb levels and female gender were the main variables relating to transfusion. Even in experienced high-volume centers, transfusion is still necessary in a considerable number of patients.

Blood Transfusion and Outcome After Transfemoral Transcatheter Aortic Valve Replacement

“…Previous studies documented rates of blood transfusion after TAVR of 25% to 39% in series with a prevalence of anemia ranging from 45% to 57%. [5][6][7][8] The present study documented a rate of RBC transfusion of 16% in the context of a prevalence of anemia of 46%. These figures suggested that, despite a lack of a policy of preoperative optimization of hemoglobin, in this nationwide series the risk of severe bleeding requiring transfusion was rather low and decreased over time.…”

“…The negative prognostic effect of blood transfusion has been largely demonstrated in cardiac surgery, 22 whereas only a few studies of small size investigated this issue in patients undergoing TAVR. [4][5][6][7][8]23,24 This setting provides important advantages in investigating the effect of transfusions in patients undergoing cardiovascular interventions. Indeed, the minimally invasive nature of TAVR allows a more reliable evaluation of the effects of perioperative anemia and blood transfusion without the confounding effect of significant hemodilution and other detrimental effects of cardiopulmonary bypass seen in patients undergoing cardiac surgery.…”

“…2 Interestingly, these studies showed a significant decrease in the rates of red blood cell (RBC) transfusion after TAVR during the most recent years. [1][2][3] Still, a few previous studies [4][5][6][7][8] documented a high frequency of RBC transfusion after TAVR with a negative impact on the outcome. However, most of these studies were institutional series of limited size with short follow-up and without a thorough analysis of important bleeding-related variables, such as the amount of RBC transfusions, need of operation to treat severe bleeding, or drop of hemoglobin level.…”

Periprocedural anemia management in severe aortic stenosis patients undergoing transcatheter aortic valve implantation

“…Severe procedural adverse events, procedural experience (patient number), pre-and periprocedural anemia, and female gender have been identified as dependent variables for RBC transfusion [38]. Particularly a preprocedural hemoglobin value below 9.5 g/dL was also associated as an independent variable with a markedly increased need for transfusion [38].…”