Periprocedural transfusion in patients undergoing transfemoral transcatheter aortic valve implantation

Catheter Cardiovasc Interv. 2018 Jul;92(1):141-148. doi: 10.1002/ccd.27382. Epub 2017 Nov 11.

Abstract

Objectives: The aim of this investigation was to identify patient's characteristics and periprocedural variables related to periprocedural transfusion in transfemoral Transcatheter Aortic Valve Implantation (tf-TAVI).

Background: Transfusion of allogenic red-blood cells (RBC) in tf-TAVI and the number of transfused units has been linked to an increased 30-day mortality. In line with the trend of minimization and cost-effectiveness, transfusion should be avoided, wherever possible.

Methods: Between 2007 and 2015, 1,734 procedures were analyzed from our prospective registry for RBC-transfusion. Multiple logistic regression analysis was used to identify the dependent variables.

Results: 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.

Keywords: anesthesia; blood transfusion; transcatheter aortic valve replacement.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anemia / blood
  • Anemia / complications
  • Anemia / diagnosis
  • Anemia / therapy*
  • Aortic Valve / surgery*
  • Biomarkers / blood
  • Catheterization, Peripheral / adverse effects
  • Catheterization, Peripheral / methods*
  • Erythrocyte Transfusion* / adverse effects
  • Female
  • Femoral Artery*
  • Heart Valve Diseases / complications
  • Heart Valve Diseases / diagnosis
  • Heart Valve Diseases / surgery*
  • Hemoglobins / metabolism
  • Humans
  • Male
  • Perioperative Care / adverse effects
  • Perioperative Care / methods*
  • Punctures
  • Registries
  • Risk Factors
  • Sex Factors
  • Time Factors
  • Transcatheter Aortic Valve Replacement / adverse effects
  • Transcatheter Aortic Valve Replacement / methods*
  • Treatment Outcome

Substances

  • Biomarkers
  • Hemoglobins