Early Adverse Impact of Transfusion After Transcatheter Aortic Valve Replacement: A Propensity-Matched Comparison From the TRITAVI Registry

Marco Zimarino, Marco Barbanti, George D. Dangas, Luca Testa, Davide Capodanno, Giulio G. Stefanini, Francesco Radico, Michele Marchioni, Ignacio Amat-Santos, Tommaso Piva, Francesco Saia, Bernhard Reimers, Carlo De Innocentiis, Andrea Picchi, Alessandro Toro, Tania Rodriguez-Gabella, Elisa Nicolini, Carolina Moretti, Sabina Gallina, Nicola MaddestraFrancesco Bedogni, Corrado Tamburino

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Background: There is no consensus on the benefit of red blood cell (RBC) transfusion after transcatheter aortic valve replacement. Methods: The multicenter Transfusion Requirements in Transcatheter Aortic Valve Implantation (TRITAVI) registry retrospectively included patients after transfemoral transcatheter aortic valve replacement; 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. We repeated propensity score-matching according to the hemoglobin nadir, hemoglobin drop, and in the subgroup of uncomplicated patients, without major vascular complications or major bleeding. Results: Among 2587 patients, RBC transfusion was administered in 421 cases (16%). The primary end point occurred in 104 (4.0%) patients, myocardial infarction in 9 (0.4%), cerebrovascular accident in 38 (1.5%), and acute kidney injury in 125 (4.8%) cases. In the 842 propensity-matched patients, RBC transfusion was associated with increased mortality (hazard ratio, 2.07 [95% CI, 1.06-4.05]; P=0.034) and acute kidney injury (hazard ratio, 4.35 [95% CI, 2.21-8.55]; P<0.001). 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 (P=0.044), major bleeding (P=0.041), and RBC transfusion (P=0.048) were independent correlates of 30-day mortality. Conclusions: RBC transfusion correlates with increased mortality and acute kidney injury early after transcatheter aortic valve replacement and is an independent predictor of 30-day mortality, irrespective of periprocedural major bleeding and vascular complications. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03740425.

Original languageEnglish
Pages (from-to)E009026
JournalCirculation: Cardiovascular Interventions
Volume13
Issue number12
DOIs
StatePublished - 1 Dec 2020

Keywords

  • acute kidney injury
  • blood substitutes
  • blood transfusion
  • prognosis
  • transcatheter aortic valve replacement

Fingerprint

Dive into the research topics of 'Early Adverse Impact of Transfusion After Transcatheter Aortic Valve Replacement: A Propensity-Matched Comparison From the TRITAVI Registry'. Together they form a unique fingerprint.

Cite this