Transcatheter aortic valve implantation in Jehovah's Witness patients with symptomatic severe aortic valve stenosis
German Heart Institute Berlin, Berlin, Germany.Interactive Cardiovascular and Thoracic Surgery (Impact Factor: 1.16). 06/2012; 15(4):766-8. DOI: 10.1093/icvts/ivs216
Transcatheter aortic valve implantation (TAVI) is currently reserved for high or prohibitive surgical-risk patients with aortic valve stenosis. We report on successful TAVI in two Jehovah's witness patients. It offers a simple and effective treatment of severe aortic valve stenosis in high-risk patients who refuse the use of allogeneic blood and blood products. © 2012 The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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ABSTRACT: Background: Transcatheter aortic valve replacement (TAVR) is less invasive than surgical aortic valve replacement and may be preferred for patients, who refuse blood transfusions. Objectives: Our study sought to define transfusion rates in TAVR, identify predictors and develop recommendations for patients, who refuse transfusions. Methods: A large cohort of consecutive patients undergoing TAVR was prospectively studied. Blood loss and transfusion rates were observed in patients undergoing transfemoral (TF-TAVR) and transapical TAVR (TA-TAVR). Predictors for transfusion were investigated in a multivariate model. Results: Of 373 consecutive patients, 270 underwent TF-TAVR and 103 TA-TAVR. Transfusion rates were significantly lower in TF-TAVR than TA-TAVR (11.1 % versus 41.7 %; p < 0.001). In patients who did not receive transfusions, blood loss was significantly lower in TF-TAVR than TA-TAVR (23.6 ± 12.2 g/l versus 28.9 ± 13.7 g/l; p = 0.004), but did not differ in transfused patients (36.9 ± 12.9 g/l versus 33.4 ± 21.2 g/l; p = 0.428). Predictors for transfusions were low baseline hemoglobin, female sex, low body weight and decreased renal function. In 7 Jehovah's Witness patients, who refuse transfusions, no vascular complications occurred and clinical outcome was excellent. Conclusion: In patients, who refuse transfusions, TAVR may be performed with good clinical outcomes provided a high baseline hemoglobin level, careful management of the access site and strict measurements to reduce blood loss. TF-TAVR is associated with less blood loss and a lower rate of transfusions than TA-TAVR, and may be the preferred option for patients, who refuse transfusions. © 2014 Wiley Periodicals, Inc.
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