The authors sought to assess the impact of a preoperative blood conservation approach in treating anaemia and preventing blood transfusions in patients undergoing transcatheter aortic valve implantation (TAVI). As of March 2013, all anaemic TAVI candidates were referred to the blood conservation clinic. Anaemic patients were treated with either oral iron only, intravenous iron only, erythropoietin only or intravenous iron in combination with erythropoietin.
On average, haemoglobin concentrations increased by 10 g/L and the average blood transfusion rate decreased from 33.3% before programme initiation to 15.3% after implementation (P < 0.001). Unfortunately, sample size was insufficient to demonstrate a significant decrease in stroke or mortality at 30 days. The incididence of major bleeding was similar before and after programme implementation, but that would be expected. This article shows that patients awaiting a TAVI procedure can be treated successfully for their preoperative anaemia and that such treatment will reduce periprocedural transfusions. However, the question remains: what does this do to outcome (major morbidity and mortality)? – Jean-François Hardy