Recovery from Anemia in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation - Prevalence, Predictors and Clinical Outcome

Introduction: Preoperative anemia is common in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and has been linked to a poorer outcome - including a higher 1-year mortality. The aim of this study was to investigate the impact of successful TAVI on baseline anemia. Methods: A total of 253 patients who survived at least 1 year following TAVI were included in this study. The prevalence, predictors and clinical outcome of hemoglobin (Hb)-recovery were assessed. Results: The prevalence of baseline anemia was 49% (n=124) -recovery from anemia occurred in 40% of the anemic patients (n=49) at 1 year after TAVI with an increase in mean Hb-level of 1.35 g/dL from baseline. This increase was not related to an improvement in renal function. At multivariate analysis, a high peak gradient (OR 4.82, P=0.003) was shown to be an independent predictor for Hb-recovery, while blood transfusion (OR 0.31, P=0.038) and chronic kidney disease (CKD, OR 0.33, P=0.043) were identified as negative predictors at, respectively, one and two years after TAVI. When compared to patients without baseline anemia, those anemic patients with Hb-recovery had a similar functional improvement (OR 0.98, P=0.975), whereas those without Hb-recovery had a significantly lower likelihood of functional improvement with >= 2 NYHA classes (OR 0.49, P=0.034) and a higher likelihood of re-hospitalization within the first year after TAVI (OR 1.91, P=0.024). Conclusion: Recovery from anemia occurs in 40% of anemic patients at 1 year after TAVI - mainly in those with a high gradient and without CKD. Blood transfusion was found to have a transient adverse effect on this Hb-recovery. Finally, anemic patients without Hb-recovery experience less functional improvement and have a higher re-hospitalization rate within the first year after TAVI.