TY  - BOOK
AU  - Ben-Dor, Itsik
AU  - Cellamare, Matteo
AU  - Garcia-Garcia, Hector M
AU  - Merdler, Ilan
AU  - Reddy, Pavan
AU  - Rogers, Toby
AU  - Satler, Lowell F
AU  - Waksman, Ron
AU  - Zhang, Cheng
TI  - Impact of Significant Hemoglobin Drop Without Bleeding in Patients Undergoing Transcatheter Aortic Valve Replacement
SN  - 2047-9980
PY  - 2024///
KW  - *Aortic Valve Stenosis
KW  - *Hemoglobins
KW  - *Hospital Mortality
KW  - *Transcatheter Aortic Valve Replacement
KW  - Aged
KW  - Aged, 80 and over
KW  - Aortic Valve Stenosis/mo [Mortality]
KW  - Aortic Valve Stenosis/su [Surgery]
KW  - Female
KW  - Hemoglobins/an [Analysis]
KW  - Hemoglobins/me [Metabolism]
KW  - Humans
KW  - Male
KW  - Retrospective Studies
KW  - Risk Assessment/mt [Methods]
KW  - Risk Factors
KW  - Transcatheter Aortic Valve Replacement/ae [Adverse Effects]
KW  - Transcatheter Aortic Valve Replacement/mo [Mortality]
KW  - Treatment Outcome
KW  - Curated
KW  - MedStar Heart & Vascular Institute
KW  - MedStar Washington Hospital Center
KW  - Advanced Cardiac Catheterization Research Fellowship
KW  - Journal Article
N2  - BACKGROUND: Hemoglobin (Hgb) drop without bleeding is common among patients undergoing transcatheter aortic valve replacement; however, the clinical implications of significant Hgb drop have not been fully evaluated; CONCLUSIONS: Hgb drop without bleeding is common among patients undergoing transcatheter aortic valve replacement and may represent a higher risk of periprocedural death. Blood transfusion increases short- and midterm mortality risk in patients with and without bleeding, supporting a restrictive transfusion strategy; METHODS AND RESULTS: Consecutive patients undergoing transcatheter aortic valve replacement at our institution from 2011 to 2021 were retrospectively reviewed. Three groups were assessed: no Hgb drop and no bleed (NoD-NoB [reference group]), Hgb drop with bleed, and Hgb drop and no bleed (D-NoB). Hgb drop was defined as >=3 g/dL decrease from pre- to post-transcatheter aortic valve replacement. Outcomes of interest were in-hospital death and 1-year all-cause mortality. A total of 1851 cases with complete Hgb data were included: NoD-NoB: n=1579 (85.3%); D-NoB: n=49 (2.6%); Hgb drop with bleed: n=223 (12.6%). Compared with NoD-NoB, the D-NoB group was older (81.1 versus 78.9 years of age) with higher preprocedure Hgb (12.9 versus 11.7 g/dL). In-hospital death rate was higher among patients with D-NoB versus NoD-NoB (4.5% versus 0.8%, P<0.001) and similar to Hgb drop with bleed (4.5% versus 4.1%, P=0.999). Predictors of in-hospital death were D-NoB (odds ratio [OR], 3.45 [95% CI, 1.32-8.69]) and transfusion (OR, 10.6 [95% CI, 4.25-28.2]). Landmark survival analysis found that D-NoB experienced 1-year mortality rate comparable to NoD-NoB, whereas Hgb drop with bleed had higher midterm mortality (hazard ratio [HR], 3.2 [95% CI, 1.83-5.73]), and transfusion continued to impact mortality (HR, 2.5 [95% CI, 1.79-3.63])
UR  - https://dx.doi.org/10.1161/JAHA.123.032291
ER  -