Association Between Red Blood Cell Transfusion and Clinical Outcomes Among Patients Undergoing Transcatheter Aortic Valve Replacement

Reply: “Sensitivity” and “specificity” reduction of blood transfusion after transcatheter aortic valve replacement: Is that all that matters?

“…6 On the other hand, the STS/ACC TVT Registry does not include TAVR procedures performed as part of investigational device exemption trials, and previous studies have shown lower rates of transfusion in clinical trial populations. 7,8 Finally, the results of our current study using the National Inpatient Sample (NIS) database 2 are consistent with findings from a single-center study 9 as well as the STS/ACC TVT Registry, 10 both of which also demonstrated that RBC transfusion was associated with worse outcomes in patients undergoing TAVR. Thus, despite the modest sensitivity of ICD-9-CM codes for RBC transfusion, we believe that the results of our propensity-matched analysis with the NIS database are reliable and provide important insights into the association between RBC transfusion and outcomes in patients undergoing TAVR.…”

Reply: Analysis of administrative claims data provides valid and meaningful conclusions despite its imperfections

“…6 On the other hand, the STS/ACC TVT Registry does not include TAVR procedures performed as part of investigational device exemption trials, and previous studies have shown lower rates of transfusion in clinical trial populations. 7,8 Finally, the results of our current study using the National Inpatient Sample (NIS) database 2 are consistent with findings from a single-center study 9 as well as the STS/ACC TVT Registry, 10 both of which also demonstrated that RBC transfusion was associated with worse outcomes in patients undergoing TAVR. Thus, despite the modest sensitivity of ICD-9-CM codes for RBC transfusion, we believe that the results of our propensity-matched analysis with the NIS database are reliable and provide important insights into the association between RBC transfusion and outcomes in patients undergoing TAVR.…”

Blood Transfusion and Outcome After Transfemoral Transcatheter Aortic Valve Replacement

“…Previous studies documented rates of blood transfusion after TAVR of 25% to 39% in series with a prevalence of anemia ranging from 45% to 57%. [5][6][7][8] The present study documented a rate of RBC transfusion of 16% in the context of a prevalence of anemia of 46%. These figures suggested that, despite a lack of a policy of preoperative optimization of hemoglobin, in this nationwide series the risk of severe bleeding requiring transfusion was rather low and decreased over time.…”

“…The negative prognostic effect of blood transfusion has been largely demonstrated in cardiac surgery, 22 whereas only a few studies of small size investigated this issue in patients undergoing TAVR. [4][5][6][7][8]23,24 This setting provides important advantages in investigating the effect of transfusions in patients undergoing cardiovascular interventions. Indeed, the minimally invasive nature of TAVR allows a more reliable evaluation of the effects of perioperative anemia and blood transfusion without the confounding effect of significant hemodilution and other detrimental effects of cardiopulmonary bypass seen in patients undergoing cardiac surgery.…”

“…2 Interestingly, these studies showed a significant decrease in the rates of red blood cell (RBC) transfusion after TAVR during the most recent years. [1][2][3] Still, a few previous studies [4][5][6][7][8] documented a high frequency of RBC transfusion after TAVR with a negative impact on the outcome. However, most of these studies were institutional series of limited size with short follow-up and without a thorough analysis of important bleeding-related variables, such as the amount of RBC transfusions, need of operation to treat severe bleeding, or drop of hemoglobin level.…”