Transfusion and Mortality After Transcatheter Aortic Valve Replacement

Blood transfusions are a common practice in patients undergoing transcatheter aortic valve replacement (TAVR), despite a decline in their use in recent years due to technological and procedural advancements. Nevertheless, approximately 10-16% of patients still receive perioperative transfusions, often without clear clinical benefit. Previous studies have shown an association between transfusions and increased mortality in cardiac patients, attributed to various pathophysiological mechanisms, including impaired oxygen delivery to tissues and a higher risk of thrombotic events. In this context, the multicenter TRITAVI registry analyzed the impact of transfusions on 2,587 patients undergoing TAVR in Italy and Spain, using propensity matching to balance baseline characteristics between groups. The results showed that transfusions were associated with a twofold increase in 30-day mortality and a fourfold increase in complications such as stroke and kidney injury. However, in patients without bleeding or vascular complications, the association between transfusions and mortality was no longer significant after adjusting for confounding factors. While this study confirms an association between transfusions and adverse outcomes, it does not establish a direct causal relationship. The debate remains open on the need for more restrictive transfusion strategies in TAVR patients to reduce complication risks and improve postoperative prognosis. Future randomized studies are needed to determine the optimal transfusion threshold in this high-risk population.