title: Adverse impact of bleeding and transfusion on the outcome post-transcatheter aortic valve implantation: insights from the Pooled-RotterdAm-Milano-Toulouse In Collaboration Plus (PRAGMATIC Plus) initiative.
abstract: BACKGROUND
  Little is known about the impact of bleeding and red blood cells transfusion (RBC) on the outcome post transcatheter aortic valve implantation (TAVI).
  
  
  METHODS
  Between November 2005 and August 2011, 943 consecutive patients underwent TAVI. Bleeding was assessed according to the Valve Academic Research Consortium definitions. Patients receiving RBC were compared to those not requiring transfusion.
  
  
  RESULTS
  Life-threatening and major bleedings occurred respectively in 13.9% and 20.9% of the patients, significantly more frequently in the RBC cohort. Vascular complications occurred in 23.2% of the patients. Major and minor vascular complications were more frequent in the RBC group: 19.3 vs 5.2%, P < .001; 15.3 vs 9%, P = .003, respectively. Thirty-day all-cause mortality was 7.2%. Of the overall cohort, 38.9% required RBC transfusion; those receiving at least 4 U of RBC had higher 30-day all-cause mortality than those receiving 1 to 4 U of RBC and those not requiring transfusion: 14.4%, vs 6.3% vs 6.3%, respectively, P = .008. By multivariate analysis, transfusion of RBC was associated with an increased 30-day and 1-year mortality. Major stroke and all stages of acute kidney injury were significantly more frequent in the RBC cohort.
  
  
  CONCLUSIONS
  Bleeding is frequent after TAVI, mainly driven by vascular complications. RBC transfusion was associated with increased mortality at 1 year and increased risk of major stroke and acute kidney injury. Specific scores are needed to identify the patients at higher risk for TAVI-related bleeding and RBC transfusion.
authors.affiliation: Clinique Pasteur, Toulouse, France. d.tchetche@clinique-pasteur.com
authors.forename: Didier
authors.initials: D
authors.lastname: Tchetche
authors.forename: Robert M A
authors.initials: RM
authors.lastname: Van der Boon
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dumonteil
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Nicolas M
authors.initials: NM
authors.lastname: Van Mieghem
authors.forename: Bruno
authors.initials: B
authors.lastname: Farah
authors.forename: Gill L
authors.initials: GL
authors.lastname: Buchanan
authors.forename: Redouane
authors.initials: R
authors.lastname: Saady
authors.forename: Bertrand
authors.initials: B
authors.lastname: Marcheix
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Didier
authors.initials: D
authors.lastname: Carrie
authors.forename: Peter P T
authors.initials: PP
authors.lastname: De Jaegere
authors.forename: Jean
authors.initials: J
authors.lastname: Fajadet
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D006328:Cardiac Catheterization; D015331:Cohort Studies; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome