Quality Improvement in the Practice of Blood Transfusions in Transcatheter Aortic Valve Implantation Procedures

TL;DR

This study shows that reducing blood cross-matching for TAVI patients is safe and saves costs without harming patient outcomes.

Contribution

Demonstrates the safety and cost-effectiveness of reducing blood cross-matching for non-surgical transfemoral TAVI patients.

Findings

Only 1.28% of patients required blood transfusion after the protocol change.

Reducing cross-matched units led to significant cost savings without compromising safety.

One patient needed more than two units due to vascular closure device failure.

Abstract

Background

Transcatheter aortic valve implantation (TAVI) is a standard procedure for symptomatic severe aortic stenosis and is especially favored in patients with a high surgical risk. Although TAVI is minimally invasive, blood transfusion remains a relevant postoperative concern. Glenfield Hospital routinely cross-matched four units of packed red cells (PRCs) for every TAVI patient. This practice put significant strain on transfusion services and hospital resources with the increased volume of TAVIs performed, from 182 cases in 2021 to 543 in 2024. Changes in data regarding blood transfusion demands allowed for changing the practice to cross-matching only two units of PRCs for non-surgical transfemoral TAVI patients starting June 2024. This study aimed to assess the safety and cost implications before and after implementing the revised blood cross-matching protocols for non-surgical transfemoral TAVI patients.

Methodology

A retrospective study was performed among all TAVI cases at Glenfield Hospital from June 1 to December 31, 2024. The study used the National Institute for Cardiovascular Outcomes Research TAVI database. Patients were split into different groups according to approach (non-surgical transfemoral access vs. surgical access). The primary aim was measurement of the transfusion rate and the number of units transfused after the TAVI procedure, and the secondary aim was to assess the safety and cost implications before and after implementing the revised blood cross-matching protocols for non-surgical transfemoral TAVI patients.

Results

Out of 312 patients (mean age = 81 ± 6 years; 39% female), 94% received non-surgical transfemoral TAVI. Only four (1.28%) patients required PRC transfusion. Only one (0.32%) patient required more than two units following vascular closure device failure, requiring surgical repair.

Conclusions

This single-center study offers evidence to justify the modified practice of limiting cross-matching of blood to two PRC units, or doing group and save only, in non-surgical transfemoral TAVI patients. The practice is safe as well as cost-effective and leads to significant cost savings without compromising patient care. However, further multicenter, prospective studies with long-term follow-up are justified to replicate these findings and establish broader implications for patient care.

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