Consecutive patients (n = 597) undergoing transfemoral TAVI were prospectively enrolled. Periprocedural Hb levels, RBC transfusions, and major/life-threatening bleeding events were documented and analyzed.
In the entire cohort, mean Hb level decreased after TAVI (11.8 ± 1.4 to 9.5 ± 1.3 g/dL; P < 0.001). Major/life threatening bleeding occurred in 66 (10.1%) patients, and 179 (30%) patients received RBC transfusions. Major/life threatening bleeding was not independently associated with mortality when adjusted for Hb drop and RBC transfusion. Among patients with an Hb drop of < 3 g/dL, those who received RBC transfusions had a higher mortality (hazard ratio [HR], 1.9; confidence interval [CI], 95% CI, 1.2-2.9; P = 0.004). Among patients with an Hb drop of ≥ 3 g/dL, the Hb drop had no significant impact on survival (HR, 1.5; 95% CI, 0.7-2.9; P = 0.2); however, patients who received RBC transfusions had a significantly higher mortality (HR, 4.1; 95% CI, 2.2-7.7; P < 0.001). The use of RBC transfusions decreased gradually over the duration of the study.
An Hb drop is frequently observed after TAVI. RBC transfusions are strongly associated with increased long-term mortality in these patients, regardless of the degree of Hb drop or major bleeding.