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There is an ongoing discussion about the impact of the transfusion of red blood cells (RBCs) on clinical outcomes in cardiac surgical patients. Compared with non-transfused patients, a recent retrospective analysis in patients undergoing transfemoral transcatheter aortic valve implantation (TAVI) indicates a dramatic increase in 30-day mortality in transfused patients, but no difference in 1-year mortality. We assessed the effect of the transfusion of 1-2 RBCs on early and late mortality in patients undergoing transapical (TA) TAVI. There were 430 patients who were not transfused (RBC-) and 209 patients who have received transfusions (RBC+). In the RBC- and RBC+ group, 30-day mortality rates were 2.8 and 1.4%, respectively. The propensity score-adjusted odds ratio of 30-day mortality was for the RBC+ group (reference: RBC- group) 0.44 (95% CI 0.11; 1.79; P = 0.252). One-year mortality rates were 12.1 and 17.6%, respectively. The propensity score-adjusted hazard ratio of 1-year mortality was higher in the RBC+ group than in the RBC- group (1.75 [95% CI 1.08;2.82]; P = 0.023). We conclude that in the group of very high-risk patients undergoing TA-TAVI, transfusion of 1-2 RBCs is not associated with an increased early mortality. However, adverse effects of transfusions on long-term survival cannot be definitely ruled out.

interactive cardiovascular and thoracic surgery

Transfusion of small amounts of leucocyte-depleted red blood cells and mortality in patients undergoing transapical transcatheter aortic valve replacement