title: Impact of blood transfusions on short- and long-term mortality in patients who underwent transcatheter aortic valve implantation.
abstract: Baseline anemia is associated with transfusions and increased risk of mortality in patients who underwent cardiac surgery and percutaneous coronary intervention. The impact of blood transfusions in anemic patients who underwent transcatheter aortic valve implantation (TAVI) remains unclear. All patients who underwent transfemoral TAVI at our institution were retrospectively included. We determined the effect of blood transfusions on short- and long-term mortality and its interaction with baseline hemoglobin levels and bleeding complications. Additionally, we evaluated baseline hemoglobin effect on mortality. A total of 332 patients were included. All patients (99%) except 2 (1%) met the definition for anemia. Of the 332 patients, 124 (37%) received a blood transfusion and 208 (63%) did not. Blood transfusions were associated with increased in-hospital (p <0.001), 30-day (p <0.001), and 1-year (28% vs 13%, p = 0.001) mortality; however, after a landmark analysis, the effect of blood transfusion on mortality was only seen within 30 days of the procedure (p = 0.001). The increased risk of mortality associated with blood transfusion was present after multivariate adjustment at 30 days (hazard ratio 3.59 [1.04 to 12.4]; p = 0.04). Major vascular complications were a correlate for short- and long-term death. In contrast, baseline hemoglobin level and bleeding complications were not independently associated with mortality. The p value for interaction was not significant between transfusion and hemoglobin level and for transfusion and bleeding complication and transfusion and major vascular complication. In conclusion, the presence of anemia in patients who underwent TAVI does not affect mortality. Transfusion is a correlate of all-cause mortality in this patient population and should be used with caution.
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Ricardo O
authors.initials: RO
authors.lastname: Escárcega
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lipinski
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Magalhaes
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Nevin C
authors.initials: NC
authors.lastname: Baker
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Sa'ar
authors.initials: S
authors.lastname: Minha
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Petros G
authors.initials: PG
authors.lastname: Okubagzi
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Fang
authors.initials: F
authors.lastname: Chen
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Itsik
authors.initials: I
authors.lastname: Ben-Dor
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC. Electronic address: ron.waksman@medstar.net.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D001803:Blood Transfusion; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*