Periprocedural transfusion in patients undergoing transfemoral transcatheter aortic valve implantation
Corresponding Author
N Patrick Mayr MD
Institut für Anästhesiologie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636 Germany
Correspondence N.Patrick Mayr, M.D. Institut für Anästhesiologie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, D-80636 Munich, F.R. Germany. Email: [email protected]Search for more papers by this authorGunther Wiesner MD
Institut für Anästhesiologie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636 Germany
Search for more papers by this authorAlexander Hapfelmeier Dipl.Stat, PhD
Institut für Medizinische Statistik und Epidemiologie, Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr. 22, Munich, D-81675 Germany
Search for more papers by this authorPieter van der Starre MD
Department of Anesthesiology and Perioperative Medicine, Stanford University School of Medicine, 300 Pasteur Drive, MC 5640, Stanford, California, 94305
Search for more papers by this authorOliver Husser MD, PhD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636 Germany
Search for more papers by this authorSabine Bleiziffer MD
Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636 Germany
Search for more papers by this authorHeribert Schunkert MD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636 Germany
DZHK, partner site Munich Heart Alliance, Munich, Germany
Search for more papers by this authorRüdiger Lange MD
Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636 Germany
DZHK, partner site Munich Heart Alliance, Munich, Germany
Search for more papers by this authorPeter Tassani-Prell MD
Institut für Anästhesiologie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636 Germany
Search for more papers by this authorKlaus Martin MD, PhD
Institut für Anästhesiologie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636 Germany
Search for more papers by this authorCorresponding Author
N Patrick Mayr MD
Institut für Anästhesiologie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636 Germany
Correspondence N.Patrick Mayr, M.D. Institut für Anästhesiologie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, D-80636 Munich, F.R. Germany. Email: [email protected]Search for more papers by this authorGunther Wiesner MD
Institut für Anästhesiologie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636 Germany
Search for more papers by this authorAlexander Hapfelmeier Dipl.Stat, PhD
Institut für Medizinische Statistik und Epidemiologie, Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr. 22, Munich, D-81675 Germany
Search for more papers by this authorPieter van der Starre MD
Department of Anesthesiology and Perioperative Medicine, Stanford University School of Medicine, 300 Pasteur Drive, MC 5640, Stanford, California, 94305
Search for more papers by this authorOliver Husser MD, PhD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636 Germany
Search for more papers by this authorSabine Bleiziffer MD
Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636 Germany
Search for more papers by this authorHeribert Schunkert MD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636 Germany
DZHK, partner site Munich Heart Alliance, Munich, Germany
Search for more papers by this authorRüdiger Lange MD
Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636 Germany
DZHK, partner site Munich Heart Alliance, Munich, Germany
Search for more papers by this authorPeter Tassani-Prell MD
Institut für Anästhesiologie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636 Germany
Search for more papers by this authorKlaus Martin MD, PhD
Institut für Anästhesiologie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, Lazarettstr. 36, Munich, D-80636 Germany
Search for more papers by this authorAbstract
Objectives
The aim of this investigation was to identify patient's characteristics and periprocedural variables related to periprocedural transfusion in transfemoral Transcatheter Aortic Valve Implantation (tf-TAVI).
Background
Transfusion of allogenic red-blood cells (RBC) in tf-TAVI and the number of transfused units has been linked to an increased 30-day mortality. In line with the trend of minimization and cost-effectiveness, transfusion should be avoided, wherever possible.
Methods
Between 2007 and 2015, 1,734 procedures were analyzed from our prospective registry for RBC-transfusion. Multiple logistic regression analysis was used to identify the dependent variables.
Results
Transfusion was considered necessary in 14% (n = 243) of the patients. Female gender (OR [95% CI]) (1.680 [1.014-2.783]) and preprocedural moderate (7.594 [4.404-13.095]) and severe anemia (8.202 [0.900-74.752]) according to WHO were the most important preprocedural variables. Periprocedural, pericardial effusion (12.109 [3.753-39.063]), emergency extracorporeal circulation (54.5288 [6.178-481.259]) and major vascular injury (2.647 [1.412-4.962]) were related to transfusion. The same applies to moderate (4.255 [1.859-9.740]) and severe anemia (31.567 [8.560-116.416]) as well as periprocedural experience (0.072 [0.035-0.149] – 0.141[0.079-0.251], P < 0.001)
Conclusion
Procedural experience, serious adverse events, low pre- and periprocedural Hb levels and female gender were the main variables relating to transfusion. Even in experienced high-volume centers, transfusion is still necessary in a considerable number of patients.
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