Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2026
Impact of Peri-Procedural Red Blood Cell Transfusion on Clinical Outcomes in Transcatheter Aortic Valve Replacement: A Propensity-Matched Cohort Study.
СтатьяПоддержка NIH: внешняя программаНазвание и аннотация: Перевод пока не подготовлен
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Qadeer Abdul, Fouad Michele, Khawar Muneeb, Khan Muhammad Haris, Gohar Najam, Ikbariah Kamel, Bashir Qasim, Ishaq Muhammad Umer, Muhammad Awon, Iqbal Ghuman Shameer, Shenawa Elham, Khawar Mirza Muhammad Hadeed, Gaalema Diann, Jneid Hani, Shalaby Mostafa, Mortada Ibrahim
Аннотация
BACKGROUND: Red blood cell (RBC) transfusion is common after transcatheter aortic valve replacement (TAVR) to manage peri-procedural bleeding and has been associated with adverse outcomes in various studies. However, the prognostic impact of peri-procedural transfusion in TAVR patients remains unclear. This study aimed to assess the impact of peri-procedural RBC transfusion on cardiovascular outcomes in TAVR patients compared to those without transfusion.
METHODS: A retrospective cohort study was conducted using the TriNetX US Collaborative Research Network, including adults undergoing TAVR until August 31, 2025. Patients were divided into those receiving RBC transfusion (n = 3,176) and those without (n = 79,664) on the day of receiving TAVR. Propensity score matching (1:1) balanced cohorts (n = 3161 each) for demographics, comorbidities, medications, and laboratory values. Relative risks (RR) and hazard ratios (HR) were calculated using propensity-matched and Cox proportional hazard models.
RESULTS: Transfused patients had significantly higher all-cause mortality (RR 3.933; 95% CI: 2.27-6.92; p < 0.001 at 7 days; RR 1.824; 95% CI: 1.466-2.268; p < 0.001 at 3 months). Secondary outcomes showed elevated risks for MACE (RR 1.324; 95% CI: 1.073-1.633; p = 0.009 at 7 days; RR 1.199; 95% CI: 1.060-1.358; p = 0.004 at 3 months), hemodynamic instability (RR 2.063; 95% CI: 1.655-2.571; p < 0.001 at 7 days; RR 1.638; 95% CI: 1.368-1.962; p < 0.001 at 3 months), acute kidney injury (RR 1.615; 95% CI: 1.295-2.013; p < 0.001 at 7 days; RR 1.379; 95% CI: 1.196-1.591; p < 0.001 at 3 months), and post-TAVR sepsis (RR 1.184; 95% CI: 0.771-1.819; p = 0.439 at 30 days; RR 0.899; 95% CI: 0.667-1.211; p = 0.483 at 3 months). Ischemic stroke/TIA risk was modestly increased in unadjusted analyses but attenuated post-matching (RR 1.123; 95% CI: 0.823-1.534; p = 0.464 at 7 days; RR 1.219; 95% CI: 0.995-1.493; p = 0.056 at 3 months). Cox models showed statistically significant risk elevations for most outcomes, including heart failure exacerbation (HR 1.418; 95% CI: 1.311-1.533; p < 0.001).
CONCLUSIONS: Peri-procedural RBC transfusion was associated with increased risks of mortality and complications after TAVR, with attenuation over time. These findings support consideration of restrictive transfusion strategies.
METHODS: A retrospective cohort study was conducted using the TriNetX US Collaborative Research Network, including adults undergoing TAVR until August 31, 2025. Patients were divided into those receiving RBC transfusion (n = 3,176) and those without (n = 79,664) on the day of receiving TAVR. Propensity score matching (1:1) balanced cohorts (n = 3161 each) for demographics, comorbidities, medications, and laboratory values. Relative risks (RR) and hazard ratios (HR) were calculated using propensity-matched and Cox proportional hazard models.
RESULTS: Transfused patients had significantly higher all-cause mortality (RR 3.933; 95% CI: 2.27-6.92; p < 0.001 at 7 days; RR 1.824; 95% CI: 1.466-2.268; p < 0.001 at 3 months). Secondary outcomes showed elevated risks for MACE (RR 1.324; 95% CI: 1.073-1.633; p = 0.009 at 7 days; RR 1.199; 95% CI: 1.060-1.358; p = 0.004 at 3 months), hemodynamic instability (RR 2.063; 95% CI: 1.655-2.571; p < 0.001 at 7 days; RR 1.638; 95% CI: 1.368-1.962; p < 0.001 at 3 months), acute kidney injury (RR 1.615; 95% CI: 1.295-2.013; p < 0.001 at 7 days; RR 1.379; 95% CI: 1.196-1.591; p < 0.001 at 3 months), and post-TAVR sepsis (RR 1.184; 95% CI: 0.771-1.819; p = 0.439 at 30 days; RR 0.899; 95% CI: 0.667-1.211; p = 0.483 at 3 months). Ischemic stroke/TIA risk was modestly increased in unadjusted analyses but attenuated post-matching (RR 1.123; 95% CI: 0.823-1.534; p = 0.464 at 7 days; RR 1.219; 95% CI: 0.995-1.493; p = 0.056 at 3 months). Cox models showed statistically significant risk elevations for most outcomes, including heart failure exacerbation (HR 1.418; 95% CI: 1.311-1.533; p < 0.001).
CONCLUSIONS: Peri-procedural RBC transfusion was associated with increased risks of mortality and complications after TAVR, with attenuation over time. These findings support consideration of restrictive transfusion strategies.