title: Preprocedure Anemia Management Decreases Transfusion Rates in Patients Undergoing Transcatheter Aortic Valve Implantation.
abstract: Periprocedural blood transfusions are associated with long-term mortality in patients undergoing transcatheter aortic valve implantation (TAVI). We sought to assess the impact of a preoperative blood conservation approach in treating anemia and preventing blood transfusions in patients undergoing TAVI.
  
  
  
  Our cohort consisted of all patients evaluated in our structural heart clinic between January 1, 2012 and December 31, 2014. From March 2013, all anemic TAVI candidates were referred to the blood conservation clinic (BCC). We evaluated the effectiveness of the program to increase hemoglobin levels and to decrease the blood transfusion rates in the TAVI cohort. A multivariable logistic regression model was used to evaluate the association of being assessed by the BCC with receipt of a blood transfusion.
  
  
  
  The cohort included 239 patients, 62% of whom were anemic. Beginning in March 2013, 60 patients were evaluated in the BCC and treated with intravenous/oral iron or subcutaneous epoetin alfa, or both. Patients who underwent blood conservation had a significant increase in hemoglobin levels from 10.8 ± 1.1 g/dL to 11.8 ± 1.2 g/dL (P < 0.001). Implementation of the BCC was associated with a substantial decrease in the average blood transfusion rate from 33.3% before program initiation to 15.3% after implementation (P < 0.001). After adjusting for baseline hemoglobin values and comorbidities, being assessed at the BCC was strongly associated with a reduction in the need for transfusion (odds ratio, 0.28; 95% confidence interval, 0.11-0.69; P = 0.006).
  
  
  
  Preprocedural anemia management was successful in improving hemoglobin levels in anemic patients and in decreasing transfusion rates in TAVI.
authors.affiliation: Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada. Electronic address: monysh@gmail.com.
authors.forename: Mony
authors.initials: M
authors.lastname: Shuvy
authors.affiliation: Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jumana
authors.initials: J
authors.lastname: Mewa
authors.affiliation: Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
authors.forename: Rafael
authors.initials: R
authors.lastname: Wolff
authors.affiliation: Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jordan
authors.initials: J
authors.lastname: Hutson
authors.affiliation: University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation (iHPME), University of Toronto, Ontario, Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.affiliation: Blood Conservation Clinic, Sunnybrook Health Sciences Centre and Ontario Nurse Transfusion Coordinators Program (ONTraC), Toronto, Ontario, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Bentley
authors.affiliation: Blood Conservation Clinic, Sunnybrook Health Sciences Centre and Ontario Nurse Transfusion Coordinators Program (ONTraC), Toronto, Ontario, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Iacovelli
authors.affiliation: University of Toronto, Toronto, Ontario, Canada; Department of Clinical Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Jeannie
authors.initials: J
authors.lastname: Callum
authors.affiliation: Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sam
authors.initials: S
authors.lastname: Radhakrishnan
authors.affiliation: Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Fremes
authors.affiliation: Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation (iHPME), University of Toronto, Ontario, Canada.
authors.forename: Harindra C
authors.initials: HC
authors.lastname: Wijeysundera
authors.affiliation: University of Toronto, Toronto, Ontario, Canada; Department of Clinical Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Yulia
authors.initials: Y
authors.lastname: Lin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000628:therapy; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D001803:Blood Transfusion; D015992:Body Mass Index; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods / Q000401:mortality; D016896:Treatment Outcome