Perioperative bleeding requiring blood transfusions is associated with increased risk of stroke after transcatheter and surgical aortic valve replacement

Tuomas Tauriainen, Tatu Juvonen, Vesa Anttila, Pasi Maaranen, Matti Niemelä, Markku Eskola, Tuomas Ahvenvaara, Annastiina Husso, Marko P.O. Virtanen, Eeva Maija Kinnunen, Sebastian Dahlbacka, Maina Jalava, Mika Laine, Antti Valtola, Peter Raivio, Antti Vento, Juhani Airaksinen, Timo Mäkikallio, Fausto Biancari

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Abstract

Objectives: The authors aimed to investigate the impact of severe bleeding and use of red blood cell (RBC) transfusion on the development of postoperative stroke after surgical (SAVR) and transcatheter aortic valve replacement (TAVR), taken from the FinnValve registry. Design: Nationwide, retrospective observational study. Setting: Five Finnish university hospitals participated in the registry. Participants: A total of 6,463 patients who underwent SAVR (n = 4,333) or TAVR (n = 2,130). Interventions: Patients who underwent TAVR or SAVR with a bioprosthesis with or without coronary revascularization. Measurements and Main Results: The incidence of postoperative stroke after SAVR was 3.8%. In multivariate analysis, the number of transfused RBC units (odds ratio [OR], 1.098; 95% confidence interval [CI], 1.064-1.133) was one of the independent predictors of postoperative stroke. The incidence of stroke increased, along with the severity of perioperative bleeding, according to the European Coronary Artery Bypass Grafting (E-CABG) bleeding grades were as follows: grade 0, 2.2% (reference group); grade 1, 3.4% (adjusted OR, 1.841; 95% CI, 1.105-3.066); grade 2, 5.5% (adjusted OR, 3.282; 95% CI, 1.948-5.529); and grade 3, 14.8% (adjusted OR, 7.103; 95% CI, 3.612-13.966). The incidence of postoperative stroke after TAVR was 2.5%. The number of transfused RBC units was an independent predictor of stroke after TAVR (adjusted OR, 1.155; 95% CI, 1.058-1.261). The incidence of postoperative stroke increased, along with the severity of perioperative bleeding, as stratified by the E-CABG bleeding grades: E-CABG grade 0, 1.7%; grade 1, 5.3% (adjusted OR, 1.270; 95% CI, 0.532-3.035); grade 2, 10.0% (adjusted OR, 2.898; 95% CI, 1.101-7.627); and grade 3, 30.0% (adjusted OR, 10.706; 95% CI, 2.389-47.987). Conclusions: Perioperative bleeding requiring RBC transfusion and/or reoperation for intrathoracic bleeding is associated with an increased risk of postoperative stroke after SAVR and TAVR. Patient blood management and meticulous preprocedural planning and operative technique aiming to avoid significant perioperative bleeding may reduce the risk of cerebrovascular complications.

Original languageEnglish
Article number8
Number of pages3057
JournalJOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA
Volume36
Issue number8, Part B
DOIs
Publication statusPublished - Apr 2022
Publication typeA1 Journal article-refereed

Keywords

  • Aortic valve replacement
  • Bleeding
  • SAVR
  • Stroke
  • Transfusion

Publication forum classification

  • Publication forum level 1

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

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