Transfusions Linked to Increased Mortality in Anemic TAVR Patients

In patients with anemia prior to undergoing transcatheter aortic valve replacement (TAVR), the risk of short-term mortality is heightened by use of blood transfusions, according to a study published online October 14, 2014, ahead of print in the American Journal of Cardiology. Mortality risk was greatest for those who required a transfusion due to a bleeding complication.

Compared with patients who did not receive a blood transfusion, those who did had higher mean STS scores (10.3 vs 8.9; P = .008) and a higher prevalence of chronic kidney disease (65% vs 46%; P = .001).

Of the 124 patients (37%) who received a transfusion, 56% underwent percutaneous closure compared with 82% of those with no transfusion (P < .001).

Worse Outcomes With Transfusion, Especially After Bleeding

In-hospital all-cause and cardiac mortality and VARC 2 minor and life-threatening bleeding were higher in the transfusion group (table 1).

Mortality was also higher in the transfusion group at 30 days (11% vs 2%; P < .001) and 1 year (28% vs 13%; P = .001), although landmark analysis showed no difference between the groups from 30 days to 1 year (P = .1).

Patients who received blood due to bleeding complications had higher 30-day mortality than those who were transfused for another reason (18% vs 6%; P = .03), although no mortality difference was observed at 1 year (P = .07). In contrast, among nontransfused patients, mortality was similar at both 30 days and 1 year regardless of bleeding complications.

The transfusion group also experienced longer overall hospital stays as well as longer postprocedure and intensive care stays (P < .001 for all). In addition, analysis of baseline hemoglobin levels by tertile found no impact on in-hospital, 30-day, or 1-year mortality.

On multivariable analysis, blood transfusion was independently associated with 30-day mortality (HR 3.59; 95% CI 1.04-12.4), as was the occurrence of major vascular complications (HR 5.25; 95% CI 1.83-15.1). At 12 months, major vascular complications were the main correlate of death.

Possible Strategies

According to the authors, some studies suggest that “a more conservative strategy restricting blood transfusion to patients in which hemoglobin decreased [to] under 7 g/dL is at least as effective [as] and possibly superior to a more aggressive transfusion strategy in sick patients.”

But they also note an “interesting concept” from the surgical literature involving use of a perioperative blood conservation strategy to reduce the need for blood products in surgical aortic valve replacement patients (Yaffee DW, et al. Ann Thorac Surg. 2014;97:95-101).

“Perhaps a similar strategy could be implemented in patients undergoing [TAVR], which may in turn, decrease the need [for] unnecessary blood transfusions,” the study authors observe.

Source:
Escárcega RO, Lipinski MJ, Magalhaes MA, et al. Impact of blood transfusions on short- and long-term mortality in patients undergoing transcatheter aortic valve implantation. Am J Cardiol. 2014;Epub ahead of print.

Disclosures:

• The paper contains no statement regarding conflicts of interest for Dr. Waksman.

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• Anemia Present in More than Half of TAVR Patients, Raises Long-term Mortality
• Blood Transfusion Associated with Acute Kidney Injury in TAVR Patients
• Post-TAVR Transfusion Tied to Increased Mortality