000			04845nam a22007577a 4500
008			240807s20242024 xxu||||| |||| 00| 0 eng d
022			_a2047-9980
040			_aOvid MEDLINE(R)
099			_a38818933
245			_aImpact of Significant Hemoglobin Drop Without Bleeding in Patients Undergoing Transcatheter Aortic Valve Replacement.
251			_aJournal of the American Heart Association. 13(11):e032291, 2024 Jun 04.
252			_aJ Am Heart Assoc. 13(11):e032291, 2024 Jun 04.
253			_aJournal of the American Heart Association
260			_c2024
260			_fFY2024
260			_p2024 Jun 04
265			_sppublish
265			_tMEDLINE
266			_d2024-08-07
266			_z2024/05/31 07:13
520			_aBACKGROUND: 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.
520			_aCONCLUSIONS: 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.
520			_aMETHODS 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]).
546			_aEnglish
650			_a*Aortic Valve Stenosis
650			_a*Hemoglobins
650			_a*Hospital Mortality
650			_a*Transcatheter Aortic Valve Replacement
650			_aAged
650			_aAged, 80 and over
650			_aAortic Valve Stenosis/mo [Mortality]
650			_aAortic Valve Stenosis/su [Surgery]
650			_aFemale
650			_aHemoglobins/an [Analysis]
650			_aHemoglobins/me [Metabolism]
650			_aHumans
650			_aMale
650			_aRetrospective Studies
650			_aRisk Assessment/mt [Methods]
650			_aRisk Factors
650			_aTranscatheter Aortic Valve Replacement/ae [Adverse Effects]
650			_aTranscatheter Aortic Valve Replacement/mo [Mortality]
650			_aTreatment Outcome
650			_zCurated
651			_aMedStar Heart & Vascular Institute
651			_aMedStar Washington Hospital Center
656			_aAdvanced Cardiac Catheterization Research Fellowship
657			_aJournal Article
700			_aBen-Dor, Itsik _bMHVI
700			_aCellamare, Matteo _bMHVI
700			_aGarcia-Garcia, Hector M _bMHVI
700			_aMerdler, Ilan _bMHVI
700			_aReddy, Pavan _bMWHC _cAdvanced Cardiac Catheterization Research Fellowship _dMD
700			_aRogers, Toby _bMHVI
700			_aSatler, Lowell F _bMHVI
700			_aWaksman, Ron _bMHVI
700			_aZhang, Cheng _bMHVI
790			_aReddy P, Merdler I, Zhang C, Cellamare M, Ben-Dor I, Satler LF, Rogers T, Garcia-Garcia HM, Waksman R
856			_uhttps://dx.doi.org/10.1161/JAHA.123.032291 _zhttps://dx.doi.org/10.1161/JAHA.123.032291
858			_yGarcia-Garcia, Hector M _uhttps://orcid.org/0000-0001-5100-0471 _zhttps://orcid.org/0000-0001-5100-0471
858			_yReddy, Pavan _uhttps://orcid.org/0000-0001-8913-7430 _zhttps://orcid.org/0000-0001-8913-7430
858			_yRogers, Toby _uhttps://orcid.org/0000-0002-6043-3137 _zhttps://orcid.org/0000-0002-6043-3137
858			_ySatler, Lowell F _uhttps://orcid.org/0000-0001-6446-2683 _zhttps://orcid.org/0000-0001-6446-2683
858			_yWaksman, Ron _uhttps://orcid.org/0000-0002-4063-9226 _zhttps://orcid.org/0000-0002-4063-9226
942			_cART _dArticle
999			_c14589 _d14589