title: Blood transfusion is associated with impaired outcome after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  We sought to evaluate the relationship of blood transfusion after transcatheter aortic valve implantation (TAVI) and mid-term outcome to improve patient selection and periprocedural treatment.
  
  
  BACKGROUND
  Increasing evidence suggests a negative influence of blood transfusion on outcomes of patients with cardiovascular diseases. While the adverse impact of bleeding events on survival has been documented after TAVI, data on the impact of postoperative blood transfusions are scarce.
  
  
  METHODS
  TAVI was performed in 700 consecutive patients; 14.7% of TAVI patients suffered from bleeding or access site complications and were excluded from analysis to minimize confounding. Outcomes were analyzed with emphasis on blood transfusions and according to the Valve Academic Research Consortium definitions. Median follow-up duration was 364 days. Multivariable analyses were performed to identify predictors for transfusion and 1-year mortality.
  
  
  RESULTS
  33.0% of patients received blood transfusions after TAVI, irrespective of access choice. Blood transfusions were associated with a higher baseline risk profile (median logistic EuroSCORE 21.0 vs. 17.0%), increased rates of postoperative complications and impaired survival (21.2 vs. 36.1% all-cause 1-year mortality). Transfusion was an independent predictor of mortality at 1 year (OR 2.78 [CI 1.59-4.86]). Low body mass index (OR 0.94 [0.89-1.0]), low baseline hemoglobin (OR 0.39 [0.33-0.47]) and combined anticoagulation/antiplatelet therapy were identified as independent predictors of blood transfusion after TAVI.
  
  
  CONCLUSIONS
  Blood transfusions were frequently required after TAVI even in the absence of overt bleeding or access site complications and were identified as an independent predictor of impaired mid-term outcome. Optimization of baseline factors, strict blood conservation strategies, and individualized antiplatelet or anticoagulant regimens may improve outcome after TAVI.
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Seiffert
authors.forename: Lenard
authors.initials: L
authors.lastname: Conradi
authors.forename: Ann Christine
authors.initials: AC
authors.lastname: Terstesse
authors.forename: Dietmar
authors.initials: D
authors.lastname: Koschyk
authors.forename: Johannes
authors.initials: J
authors.lastname: Schirmer
authors.forename: Renate B
authors.initials: RB
authors.lastname: Schnabel
authors.forename: Sandra
authors.initials: S
authors.lastname: Wilde
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Ojeda
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schäfer
authors.forename: Hendrik
authors.initials: H
authors.lastname: Treede
authors.forename: Patrick
authors.initials: P
authors.lastname: Diemert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001803:Blood Transfusion / Q000401:mortality; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D005260:Female; D005858:Germany; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome
keywords: structural heart disease intervention; surgery; transcatheter valve implantation; valvular