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 363: 1597–1607. Hildebrand DR, Binnie NR, Aly EH. Is routine blood cross-matching necessary in elective laparoscopic colorectal surgery? Int J Surg. 2012;10 (2): 92–95. Blood and Components – Cost per Item. https: //nhsbtdbe. blob. core. windows. net/umbraco- assetscorp/34945/priceₗistbccost per-item₂024-25. pdf NHS Blood and Transplant - Blood component portfolio and prices. https: //hospital. blood. co. uk/components/portfolio and-prices/ Charges For Blood and Blood Derivatives Supplied to Non-Health Service Hospitals 2024–25. https: //www. health-ni. gov. uk/sites/default/files/publications/health/doh-hscf-13-2024. PDF Hall TC, Pattenden C, Hollobone C, Pollard C, Dennison AR. Blood transfusion policies in elective general surgery: how to optimise cross-match-to-transfusion ratios. Transfus Med Hemother. 2013;40 (1): 27–31.