title: Transfusion of small amounts of leucocyte-depleted red blood cells and mortality in patients undergoing transapical transcatheter aortic valve replacement.
abstract: There is an ongoing discussion about the impact of the transfusion of red blood cells (RBCs) on clinical outcomes in cardiac surgical patients. Compared with non-transfused patients, a recent retrospective analysis in patients undergoing transfemoral transcatheter aortic valve implantation (TAVI) indicates a dramatic increase in 30-day mortality in transfused patients, but no difference in 1-year mortality. We assessed the effect of the transfusion of 1-2 RBCs on early and late mortality in patients undergoing transapical (TA) TAVI. There were 430 patients who were not transfused (RBC-) and 209 patients who have received transfusions (RBC+). In the RBC- and RBC+ group, 30-day mortality rates were 2.8 and 1.4%, respectively. The propensity score-adjusted odds ratio of 30-day mortality was for the RBC+ group (reference: RBC- group) 0.44 (95% CI 0.11; 1.79; P = 0.252). One-year mortality rates were 12.1 and 17.6%, respectively. The propensity score-adjusted hazard ratio of 1-year mortality was higher in the RBC+ group than in the RBC- group (1.75 [95% CI 1.08;2.82]; P = 0.023). We conclude that in the group of very high-risk patients undergoing TA-TAVI, transfusion of 1-2 RBCs is not associated with an increased early mortality. However, adverse effects of transfusions on long-term survival cannot be definitely ruled out.
authors.affiliation: Institute of Anaesthesiology, NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany akoster@hdz-nrw.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Koster
authors.affiliation: Clinic for Thoracic and Cardiovascular Surgery Heart and Diabetes Centre, NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Zittermann
authors.affiliation: Clinic for Thoracic and Cardiovascular Surgery Heart and Diabetes Centre, NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Gummert
authors.affiliation: Clinic for Thoracic and Cardiovascular Surgery Heart and Diabetes Centre, NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Börgermann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017707:Erythrocyte Transfusion / Q000379:methods* / Q000401:mortality; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D017708:Leukocyte Transfusion / Q000379:methods* / Q000401:mortality; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality*; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality; D016896:Treatment Outcome
keywords: Immune-modulation; Octogenarians; Transfusion; Valve surgery