Transfusion in TAVR: Caution Is Best

Periprocedural red blood cell transfusion in transcatheter aortic valve replacement (TAVR) correlates with increased mortality and acute kidney injury. It also resulted an independent predictor of 30-day mortality, irrespective of bleeding and vascular complications. 

La prudencia es buena consejera para decidir una transfusión en el TAVI

The global trend that limits transfusion, in all procedures in general, has finally reached TAVR. 

The multicenter registry TRITAVI (Transfusion Requirements in Transcatheter Aortic Valve Implantation) retrospectively included patients undergoing transfemoral TAVR. Groups were compared using propensity score matching. 

Primary end point was mortality at 30 days, non-fatal MI and stroke. Among the secondary end points was acute kidney injury.

Propensity score took into account hemoglobin nadir, hemoglobin drop, and whether or not there were procedural complications, vascular complications, or major bleeding. 


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Of 2587 patients in the registry, 421 (16%) received transfusion. Primary end point occurred in 4% of patients in the general population, while MI rate was 0.4%, stroke 1.5% and acute kidney injury 4.8%.

After propensity score matching, 842 matched patients showed transfusion increased mortality by nearly 100% (HR: 2.07, CI 95%, 1.06 to 4.05; p=0.034) and increased acute kidney injury by a 4-fold (HR 4.35 CI 95%, 2.21 to 8.55; p<0.001).

Other variables, and the different subgroups, did not modify the impact of transfusion on events, resulting in completely independent predictors. As well as transfusion, vascular complications and major bleeding resulted independent predictors of mortality at 30 days. 

Conclusions

Red blood cell transfusion increased mortality at 30 days and acute kidney injury in the context of TAVR irrespective of major bleeding and vascular complications. 

Original Title: Early Adverse Impact of Transfusion After Transcatheter Aortic Valve Replacement. A Propensity-Matched Comparison From the TRITAVI Registry.

Reference: Marco Zimarino et al. Circ Cardiovasc Interv. 2020;13:e009026.  DOI: 10.1161/CIRCINTERVENTIONS.120.009026.


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