Differential Effects of Blood Transfusion after Surgical and Transcatheter Aortic Valve Replacement: A Propensity Matched Analysis
John Nicholas Melvan MD, PhD1, Vinod H. Thourani MD1, Jose Binongo, MS2, Hanna Jensen MD1, Jose Condado MD 3, Jessica Forcillo, MD1, Vasilis Babaliaros, MD3, and Eric L. Sarin MD1
1Division of Cardiothoracic Surgery, 2Department of Biostatistics, 3Division of Cardiology, Emory University School of Medicine
BACKGROUND: Blood (PRBC) transfusion is a known risk factor for postoperative complications following cardiac surgery. However, the differential effects of blood transfusion on clinical outcomes after surgical (SAVR) and transcatheter aortic valve replacement (TAVR) are not well described. This study compared the incidence and consequence of blood transfusion in SAVR and TAVR.
METHODS: We performed a retrospective review of 3,090 isolated aortic valve replacements at a single U.S. academic institution between 2007-2013. Demographics, timing and the number of units of blood transfused, and postoperative outcomes were compared for SAVR and TAVR. A propensity match of preoperative variables was created for SAVR and TAVR patients in order to assess the impact of blood transfusion volume on clinical outcomes.
RESULTS: Of the 3,090 patients undergoing AVR, 1,010 underwent TAVR and 2,080 SAVR. As expected, SAVR patients experienced a greater incidence of blood transfusion during hospitalization (68.8% versus 37.4%). Moreover, transfusion-associated complications including MACE (p=0.0169), pneumonia (p=0.0271), and atrial fibrillation (p=0.0164) occurred proportionately more often for SAVR compared to TAVR patients for similar units of blood transfused. After propensity matching of 476 pairs, higher rates of pneumonia (p=0.0119) and atrial fibrillation (p=0.0029) were still seen for SAVR compared to TAVR patients after comparable numbers of units of blood were transfused (Table).
CONCLUSIONS: These results demonstrate higher rates of blood transfusion for SAVR compared to TAVR patients. Moreover, for similar units of blood transfused, transfusion-associated complications including pneumonia and atrial fibrillation were more likely after SAVR compared to TAVR. While TAVR patients are by definition high risk, the difference in surgical approach alone may predispose SAVR patients more to transfusion-associated complications than TAVR patients.