Association between peri-procedural red blood cell transfusion and clinical outcomes in transcatheter aortic valve replacement: a systematic review and meta-analysis
11 affiliations
- 1McLaren Bay Region, Internal Medicine Residency Program
- 2Department of Medicine, Dow University of Health Sciences
- 3Department of Medicine, New Vision University
- 4Department of Internal Medicine, Sir Ganga Ram Hospital
- 5Department of Medicine, Velammal Medical College, Hospital and Research Institute
- 6Department of Medicine, King Edward Medical University
- 7Department of Medicine, University of North Carolina at Chapel Hill
- 8Department of Medicine, B.P. Koirala Institute of Health Sciences
- 9Department of Medicine, Khyber Girls Medical College
- 10Department of Medicine, Fortrea Inc.
- 11Faculty of Medicine, University of Medical Sciences and Technology
Abstract
Background: Peri-procedural red blood cell (RBC) transfusion is common after transcatheter aortic valve replacement (TAVR), but its relation to clinical outcomes is uncertain. This systematic review and meta-analysis assessed that association.
Methods: PubMed, Embase, ScienceDirect, and ClinicalTrials.gov were searched to April 2026 for observational comparisons of transfused and non-transfused TAVR patients. After removal of overlapping TRITAVI populations and one study at critical risk of bias, 11 studies entered the primary analysis. Binary outcomes were pooled as risk ratios (RR) with random-effects models (restricted maximum likelihood, Hartung–Knapp; 0.5 continuity correction for zero-event arms). Continuous outcomes were pooled as mean differences. Adjusted odds ratios were pooled separately. Prediction intervals were reported when at least three studies informed an estimate. Risk of bias (ROBINS-I), leave-one-out analyses, Egger's test, and GRADE were applied.
Results: Transfusion was associated with higher 30-day mortality (RR 3.42, 95% CI 1.27–9.18; I ² = 86.5%; prediction interval 0.28–41.03), 1-year mortality (RR 2.33, 95% CI 1.58–3.45; I ² = 79.9%; prediction interval 0.81–6.73), stroke (RR 1.59, 95% CI 1.25–2.03; I ² = 19.4%; prediction interval 1.00–2.53), life-threatening bleeding (RR 9.28, 95% CI 2.56–33.68; I ² = 66.2%; prediction interval 0.98–87.45), major vascular complications (RR 4.07, 95% CI 1.85–8.96; I ² = 30.8%; prediction interval 2.11–7.85), and stage 2–3 acute kidney injury (RR 2.19, 95% CI 1.39–3.44; I ² = 86.3%; prediction interval 0.69–6.91). In-hospital mortality and non-fatal myocardial infarction were not significant. Adjusted estimates pointed toward harm but were underpowered. Egger's test suggested asymmetry for stage 2–3 acute kidney injury, length of stay, and life-threatening bleeding. Leave-one-out analyses were stable for 1-year mortality, stroke, stage 2–3 acute kidney injury, and length of stay, but 30-day mortality and life-threatening bleeding shifted after omission of a single study.
Conclusion: Peri-procedural RBC transfusion in TAVR is associated with worse outcomes, most robustly for stroke, major vascular complications, and 1-year mortality. The life-threatening bleeding signal is partly definitional, because VARC criteria include transfusion volume. Findings support bleeding avoidance and restrictive thresholds; trials are needed to establish causality.
Systematic Review Registration: identifier CRD420261405548.
Related
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BibTeX
@article{rasool2026association,
title = {{Association between peri-procedural red blood cell transfusion and clinical outcomes in transcatheter aortic valve replacement: a systematic review and meta-analysis}},
author = {Faizan Rasool and Muhammad Shafay Aamir and Werner Fernandes and Eashan Aneja and Anugraha Sreeram and Muhammad Muneeb Khawar and Varsha Ganesh and Purvi Kaur Khanuja and Sanzana Tasneem and Bishal Subedi and Naima Tariq and Smrithi Rajkumar and Sandeep Bolla and Ahmed Abdelaziz Abdelrahim Mohamed and Hassaan Imtiaz and Muneeb Khawar},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = nov,
doi = {10.3389/fcvm.2026.1905897},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1905897/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association between peri-procedural red blood cell transfusion and clinical outcomes in transcatheter aortic valve replacement: a systematic review and meta-analysis
AU - Faizan Rasool
AU - Muhammad Shafay Aamir
AU - Werner Fernandes
AU - Eashan Aneja
AU - Anugraha Sreeram
AU - Muhammad Muneeb Khawar
AU - Varsha Ganesh
AU - Purvi Kaur Khanuja
AU - Sanzana Tasneem
AU - Bishal Subedi
AU - Naima Tariq
AU - Smrithi Rajkumar
AU - Sandeep Bolla
AU - Ahmed Abdelaziz Abdelrahim Mohamed
AU - Hassaan Imtiaz
AU - Muneeb Khawar
PY - 2026
DA - 2026/11/04
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1905897
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1905897/full
AB - Background: Peri-procedural red blood cell (RBC) transfusion is common after transcatheter aortic valve replacement (TAVR), but its relation to clinical outcomes is uncertain. This systematic review and meta-analysis assessed that association. Methods: PubMed, Embase, ScienceDirect, and ClinicalTrials.gov were searched to April 2026 for observational comparisons of transfused and non-transfused TAVR patients. After removal of overlapping TRITAVI populations and one study at critical risk of bias, 11 studies entered the primary analysis. Binary outcomes were pooled as risk ratios (RR) with random-effects models (restricted maximum likelihood, Hartung–Knapp; 0.5 continuity correction for zero-event arms). Continuous outcomes were pooled as mean differences. Adjusted odds ratios were pooled separately. Prediction intervals were reported when at least three studies informed an estimate. Risk of bias (ROBINS-I), leave-one-out analyses, Egger's test, and GRADE were applied. Results: Transfusion was associated with higher 30-day mortality (RR 3.42, 95% CI 1.27–9.18; I ² = 86.5%; prediction interval 0.28–41.03), 1-year mortality (RR 2.33, 95% CI 1.58–3.45; I ² = 79.9%; prediction interval 0.81–6.73), stroke (RR 1.59, 95% CI 1.25–2.03; I ² = 19.4%; prediction interval 1.00–2.53), life-threatening bleeding (RR 9.28, 95% CI 2.56–33.68; I ² = 66.2%; prediction interval 0.98–87.45), major vascular complications (RR 4.07, 95% CI 1.85–8.96; I ² = 30.8%; prediction interval 2.11–7.85), and stage 2–3 acute kidney injury (RR 2.19, 95% CI 1.39–3.44; I ² = 86.3%; prediction interval 0.69–6.91). In-hospital mortality and non-fatal myocardial infarction were not significant. Adjusted estimates pointed toward harm but were underpowered. Egger's test suggested asymmetry for stage 2–3 acute kidney injury, length of stay, and life-threatening bleeding. Leave-one-out analyses were stable for 1-year mortality, stroke, stage 2–3 acute kidney injury, and length of stay, but 30-day mortality and life-threatening bleeding shifted after omission of a single study. Conclusion: Peri-procedural RBC transfusion in TAVR is associated with worse outcomes, most robustly for stroke, major vascular complications, and 1-year mortality. The life-threatening bleeding signal is partly definitional, because VARC criteria include transfusion volume. Findings support bleeding avoidance and restrictive thresholds; trials are needed to establish causality. Systematic Review Registration: identifier CRD420261405548.
SN - 2297-055X
ER -