Radico Francesco, Biancari Fausto, D'Ascenzo Fabrizio, Saia Francesco, Luzi Giampaolo, Bedogni Francesco, Amat-Santos Ignacio J, De Marzo Vincenzo, Dimagli Arnaldo, Mäkikallio Timo, Stabile Eugenio, Blasco-Turrión Sara, Testa Luca, Barbanti Marco, Tamburino Corrado, Porto Italo, Fabiocchi Franco, Conrotto Federico, Pelliccia Francesco, Costa Giuliano, Stefanini Giulio G, Macchione Andrea, La Torre Michele, Bendandi Francesco, Juvonen Tatu, Pasceri Vincenzo, Wańha Wojciech, Benedetto Umberto, Miraldi Fabio, Dobrev Dobromir, Zimarino Marco
Department of Cardiology, ASL2 Abruzzo and Department of Neuroscience, Imaging and Clinical Sciences, 'G. D'Annunzio' University of Chieti-Pescara, Italy.
Department of Medicine, South Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland.
Int J Cardiol Heart Vasc. 2024 Jul 6;53:101460. doi: 10.1016/j.ijcha.2024.101460. eCollection 2024 Aug.
Bleeding is frequent during transcatheter aortic valve implantation (TAVI), especially when performed through a transapical approach (TA), and is associated with a worse prognosis. The present study aims to test the implication of red blood cell (RBC) transfusion and the optimal transfusion strategy in this context.
Among 11,265 participants in the multicenter TRITAVI (Transfusion Requirements in Transcatheter Aortic Valve Implantation) registry, 548 patients (4.9%) who received TA-TAVI at 19 European centers were included. One-to-one propensity score matching was performed to reduce treatment selection bias and potential confounding among transfused versus non-transfused patients. The primary endpoint of the study was the 30-day occurrence of all-cause mortality.
209 patients (38 %) received RBC transfusions. The primary endpoint occurred in 47 (8.6 %) patients. Propensity score matching identified 188 pairs of patients with and without RBC transfusion. In the propensity score-matched analysis, RBC transfusion was associated with increased 30-day mortality (HR 3.35, 95 % CI 1.51 - 7.39; p = 0.002). At multivariable cox regression analysis, RBC transfusion was an independent predictor of 30-day mortality (HR 3.07, 95 % CI 1.01-9.41, p = 0.048), as well as baseline ejection fraction (HR 0.96, 95 % CI 0.92-0.99, p = 0.043), and acute kidney injury (HR 3.95, 95 % CI 1.11-14.05, p = 0.034).
RBC transfusion is an independent predictor of short-term mortality in patients undergoing TA-TAVI, regardless of major bleeding.Clinical trial registration: https://www.clinicaltrials.gov Unique identifier: NCT03740425.
经导管主动脉瓣植入术（TAVI）期间出血频繁，尤其是经心尖途径（TA）进行该手术时，且与较差的预后相关。本研究旨在检验红细胞（RBC）输血在此情况下的影响及最佳输血策略。
在多中心TRITAVI（经导管主动脉瓣植入术的输血需求）注册研究的11265名参与者中，纳入了在19个欧洲中心接受TA-TAVI的548例患者（4.9%）。进行一对一倾向评分匹配以减少输血患者与未输血患者之间的治疗选择偏倚和潜在混杂因素。该研究的主要终点是30天全因死亡率的发生情况。
209例患者（38%）接受了RBC输血。主要终点发生在47例（8.6%）患者中。倾向评分匹配确定了188对接受和未接受RBC输血的患者。在倾向评分匹配分析中，RBC输血与30天死亡率增加相关（风险比3.35，95%置信区间1.51 - 7.39；p = 0.002）。在多变量cox回归分析中，RBC输血是30天死亡率的独立预测因素（风险比3.07，95%置信区间1.01 - 9.41，p = 0.048），同时也是基线射血分数（风险比0.96，95%置信区间0.92 - 0.99，p = 0.043）和急性肾损伤（风险比3.95，95%置信区间1.11 - 14.05，p = 0.034）的独立预测因素。
无论是否发生大出血，RBC输血都是接受TA-TAVI患者短期死亡率的独立预测因素。
https://www.clinicaltrials.gov 唯一标识符：NCT03740425。
