title: Impact of Hemoglobin Drop, Bleeding Events, and Red Blood Cell Transfusions on Long-term Mortality in Patients Undergoing Transaortic Valve Implantation.
abstract: Despite the minimally invasive nature of transcatheter aortic valve implantation (TAVI), the procedure is associated with several complications. We aimed to analyze the individual impact of bleeding events, hemoglobin (Hb) drop, and red blood cell (RBC) transfusions on prognosis and to evaluate the temporal trends in bleeding and RBC transfusions since the initiation of the TAVI program in our centre and onward.
  
  
  
  Consecutive patients (n = 597) undergoing transfemoral TAVI were prospectively enrolled. Periprocedural Hb levels, RBC transfusions, and major/life-threatening bleeding events were documented and analyzed.
  
  
  
  In the entire cohort, mean Hb level decreased after TAVI (11.8 ± 1.4 to 9.5 ± 1.3 g/dL; P < 0.001). Major/life threatening bleeding occurred in 66 (10.1%) patients, and 179 (30%) patients received RBC transfusions. Major/life threatening bleeding was not independently associated with mortality when adjusted for Hb drop and RBC transfusion. Among patients with an Hb drop of < 3 g/dL, those who received RBC transfusions had a higher mortality (hazard ratio [HR], 1.9; confidence interval [CI], 95% CI, 1.2-2.9; P = 0.004). Among patients with an Hb drop of ≥ 3 g/dL, the Hb drop had no significant impact on survival (HR, 1.5; 95% CI, 0.7-2.9; P = 0.2); however, patients who received RBC transfusions had a significantly higher mortality (HR, 4.1; 95% CI, 2.2-7.7; P < 0.001). The use of RBC transfusions decreased gradually over the duration of the study.
  
  
  
  An Hb drop is frequently observed after TAVI. RBC transfusions are strongly associated with increased long-term mortality in these patients, regardless of the degree of Hb drop or major bleeding.
authors.affiliation: Department of Cardiology, Tel-Aviv Medical Center, Tel-Aviv and the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel. Electronic address: maayan.konigstein@gmail.com.
authors.forename: Maayan
authors.initials: M
authors.lastname: Konigstein
authors.affiliation: Department of Cardiology, Tel-Aviv Medical Center, Tel-Aviv and the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Ofer
authors.initials: O
authors.lastname: Havakuk
authors.affiliation: Department of Cardiology, Tel-Aviv Medical Center, Tel-Aviv and the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Arbel
authors.affiliation: Department of Cardiology, Tel-Aviv Medical Center, Tel-Aviv and the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Ariel
authors.initials: A
authors.lastname: Finkelstein
authors.affiliation: Department of Cardiology, Tel-Aviv Medical Center, Tel-Aviv and the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Eyal
authors.initials: E
authors.lastname: Ben-Assa
authors.affiliation: Department of Cardiology, Tel-Aviv Medical Center, Tel-Aviv and the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Galit
authors.initials: G
authors.lastname: Aviram
authors.affiliation: Department of Cardiology, Tel-Aviv Medical Center, Tel-Aviv and the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Mara
authors.initials: M
authors.lastname: Hareuveni
authors.affiliation: Department of Cardiology, Tel-Aviv Medical Center, Tel-Aviv and the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Gad
authors.initials: G
authors.lastname: Keren
authors.affiliation: Department of Cardiology, Tel-Aviv Medical Center, Tel-Aviv and the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Banai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017707:Erythrocyte Transfusion; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D017052:Hospital Mortality; D006801:Humans; D007557:Israel / Q000453:epidemiology; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000401:mortality* / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D065467:Transcatheter Aortic Valve Replacement
chemical_list: D006454:Hemoglobins