2-021 Blood transfusion in patients undergoing TAVI: a quality improvement project

Background Transcatheter aortic valve implantation (TAVI) is a widely adopted procedure for patients with severe aortic stenosis (AS).¹ The requirement for packed red cell (PRC) transfusion post TAVI can significantly impact patient outcomes and resource management. In Glenfield Hospital, our standard of practice is to cross-match all TAVI patients with 4 units over the last decade, recently however, with a 3-fold increase in our TAVI procedures from 182 in 2021 to 543 in 2024, an average of 10 - 15 TAVIs performed weekly, cross-matching 4 units for 15 patients weekly exerts an enormous workload and cost on our blood transfusion department while also meeting the demands from other specialities. In 2013, 2 units of cross-matched PRC cost £294.60 as per published data² and this cost is even higher now considering inflation.³–⁵ Early study from our centre presented at PCR London valve in November 2024 demonstrated that 5.9% (111/1878) of TAVI patients required PRC transfusion following TAVI between 1stJanuary 2013 and 31stJanuary 2024 and 1.38% (26/1878) required more than 2 units. Hence, we started cross-matching non-surgical transfemoral TAVI patients with 2 units since June 2024. As with other surgical specialty,⁶ cost reduction is achievable with the incorporation of latest evidence into our practice. Objective To assess the rate of blood transfusion in TAVI patients and to assess if our new practice of cross- matching 2 units of PRC for non-surgical transfemoral TAVIs is safe and cost effective following change in practice. Methods A retrospective study of all patients undergoing TAVIs at Glenfield Hospital Leicester, United Kingdom between 1st of June and 31st of December 2024. Data were collected from the National Institute of Cardiovascular Outcome Research (NICOR) TAVI database and analysed retrospectively. Non-surgical access TAVI is defined as transfemoral TAVIs without arterial cut-down whereas the surgical access TAVIs include surgical cut-down of femoral artery, subclavian, direct aortic and transapical TAVIs and cross-matching 4 units remains for these cohorts as well as those with presence of antibodies. Since November 2024, our blood transfusion department stopped processing cross-matching requests for TAVI patients except in those with presence of antibodies however, they still continue to perform group & save as per protocol. Results A total of 312 TAVI procedures were completed during the 6 months period, mean age 81 ± 6 years, 39% were female [table 1]. TAVI was performed for severe AS in 94% of patients and 91% of TAVIs were performed due to degenerative native aortic valve disease and 7.5% as valve-in-valve TAVIs. 28% were diabetic, 9% and 7% had a previous history of stroke and transient ischaemic attack respectively, 27% had history of atrial fibrillation/atrial flutter and 5% have severely impaired left ventricular systolic function (ejection fraction, EF < 35%). Majority of cases (94%) were non-surgical transfemoral TAVI, and required local anaesthesia [table 2]. A self-expanding valve was implanted in 52% of patients with the remainder being balloon-expanding valve. Balloon pre-dilation of the aortic valve was achieved in 29% of patients whereas post-dilation was 1%. The mean procedure time was 66 ± 25 mins. Vascular closure device was used to achieve haemostasis in 93% of cases. During the 6 months of study, 4 patients (1.28%) required PRC transfusion following TAVI and only 1 patient (0.32%) required > 2 units of PRC transfusion. This was a patient who required emergency surgical repair and closure of femoral access following failure of vascular closure device. Since November 2024, our blood transfusion department stopped processing cross-matching requests for TAVIs patients except in those with presence of antibodies however, they still continue to perform group & save as per protocol. Conclusion To enhance patient safety in non-surgical TAVI patients, a group & save and/or cross-matching 2 units of PRC is safe and is associated with cost reduction. References Leon MB, Smith CR, Mack M, Miller C, Moses JW, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363:1597–1607. Hildebrand DR, Binnie NR, Aly EH. 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