RBC transfusion after TAVR increases death risk: Circulation
Italy: RBC transfusion after TAVR is associated with increased mortality and acute kidney injury (AKI), according to a recent study in the journal Circulation: Cardiovascular Interventions. The transfusion is associated with 30-day mortality, independent of periprocedural major bleeding and vascular complications.
Periprocedural bleeding in patients undergoing transcatheter aortic valve replacement (TAVR) have reduced owing to improvements in technology and technique. Still, it remains common and red blood cell (RBC) transfusion are administered frequently. Previous studies have shown associations between transfusion and worse outcomes including mortality and AKI.
However, it is unclear whether transfusion is a marker of poor outcomes or a casual driver of these events. But there is no consensus on the benefit of RBC transfusion after TAVR , the issue is not directly addressed in clinical guidelines.
The multicenter Transfusion Requirements in Transcatheter Aortic Valve Implantation (TRITAVI) registry by Marco Zimarino, Institute of Cardiology, "G. d'Annunzio" University Chieti-Pescara, Italy, and colleagues retrospectively included patients after transfemoral TAVR; propensity score-matching identified pairs of patients with and without RBC transfusion.
The primary end point was 30-day mortality; nonfatal myocardial infarction, cerebrovascular accident, and stage 2 to 3 acute kidney injury at 30 days were secondary end points.
Among 2587 patients, RBC transfusion was administered in 421 cases (16%).
Key findings of the study include:
- The primary end point occurred in 4.0% patients, myocardial infarction in 0.4%, cerebrovascular accident in 1.5%, and acute kidney injury in 4.8% cases.
- In the 842 propensity-matched patients, RBC transfusion was associated with increased mortality (hazard ratio, 2.07) and acute kidney injury (hazard ratio, 4.35).
- Interaction testing between RBC transfusion and mortality was not statistically significant in the above-mentioned subgroups, and such association was not documented in the corresponding propensity score-matched cohorts.
- In the multivariable Cox proportional hazards regression model, major vascular complications, major bleeding, and RBC transfusion were independent correlates of 30-day mortality.
"RBC transfusion correlates with increased mortality and AKI early after TAVR and is an independent predictor of 30-day mortality, irrespective of periprocedural major bleeding and vascular complications," concluded the authors.
"Early Adverse Impact of Transfusion After Transcatheter Aortic Valve Replacement: A Propensity-Matched Comparison From the TRITAVI Registry," is published in the journal Circulation: Cardiovascular Interventions.
DOI: https://www.ahajournals.org/doi/abs/10.1161/CIRCINTERVENTIONS.120.009026
