Transcatheter aortic valve implantation compared with surgical aortic valve replacement in patients with anaemia

Abstract

Objectives: We compared the outcome of anaemic patients undergoing transcatheter (TAVI) and surgical aortic valve replacement (SAVR) for severe aortic valve stenosis.

Methods: Anaemic patients (haemoglobin <13.0 g/dL in men and <12.0 g/dL in women) undergoing TAVI and SAVR from the OBSERVANT study were the subjects of this analysis.

Results: Preoperative anaemia was an independent predictor of 3-year mortality after either TAVI (HR 1.37, 95% CI 1.12–1.68) and SAVR (HR 1.63, 95% CI 1.37–1.99). Propensity score matching resulted in 302 pairs with similar characteristics. Patients undergoing SAVR had similar 30-d mortality (3.6% versus 3.3%, p = .81) and stroke (1.3% versus 2.0%, p = .53) compared with TAVI. The rates of pacemaker implantation (18.6% versus 3.0%, p < .001), major vascular damage (5.7% versus 0.4%, p < .001) and mild-to-severe paravalvular regurgitation (47.4% versus 9.3%, p < .001) were higher after TAVI, whereas acute kidney injury (50.7% versus 27.9%, p < .001) and blood transfusion (70.0% versus 38.6%, p < .001) were more frequent after SAVR. At 3-year, survival was 74.0% after SAVR and 66.3% after TAVI, respectively (p = .065), and freedom from MACCE was 67.6% after SAVR and 58.7% after TAVI, respectively (p = .049).

Conclusions: These results suggest that TAVI is not superior to SAVR in patients with anaemia.

Keywords:

• Anaemia
• anaemic
• aortic valve stenosis
• TAVR
• TAVI
• aortic valve replacement

Acknowledgements

The authors are grateful to Gabriella Badoni for her technical support in the organisational phases of the study.

Disclosure statement

Dr Tamburino receives honorary fees from Medtronic and Abbott. Dr Barbanti is a consultant for Edwards Lifesciences. The other authors report no conflicts.

Additional information

Funding

The OBSERVANT study was supported by a grant (Fasc. 1M30) from the Italian Ministry of Health and Istituto Superiore di Sanità.