Impact of Anemia and Periprocedural Hemoglobin Drop on Clinical Outcomes Following Transcatheter Aortic Valve Replacement

Background Anemia is prevalent among patients undergoing transcatheter aortic valve replacement (TAVR). The independent and combined prognostic impact of baseline anemia and periprocedural hemoglobin decline on mid-term outcomes remains poorly characterized. Methods Patients undergoing TAVR between 2016-2020 at the Cleveland Clinic were included. Patients with prior cardiac implantable electronic devices, valve-in-valve TAVR, incomplete periprocedural hemoglobin data, and overt periprocedural bleeding were excluded. Outcomes were compared using Kaplan-Meier and Cox regression survival analysis across four groups based on baseline anemia status (defined by World Health Organization criteria: hemoglobin <13 g/dL in men and <12 g/dL in women) and periprocedural hemoglobin decline (significant decline defined as ≥2 g/dL). Results Among 1,666 TAVR patients, 634 (38.0%) had no anemia with a small hemoglobin drop, 230 (13.8%) had no anemia with a large drop, 694 (41.6%) had anemia with a small drop, and 108 (6.5%) had anemia with a large drop. Three-year mortality increased stepwise across groups: 13.9%, 23.4%, 31.4%, and 40.9%, respectively ( p < 0.001). Multivariable analysis demonstrated that all comparison groups carried significantly higher risks of mortality compared to the reference group, and anemia groups carried significantly higher risks of heart failure (HF) hospitalization. Patients with both anemia and large periprocedural hemoglobin decline carried the highest risk (mortality HR 2.63, p < 0.001; HF hospitalization HR 2.39, p = 0.002). Conclusions Both baseline anemia and significant periprocedural hemoglobin decline independently and additively confer increased risk of three-year mortality, while the increased HF hospitalization risk was driven primarily by anemia. Preprocedural anemia optimization strategies may improve mid-term outcomes in TAVR candidates.