University of Oulu

Tauriainen, T., Juvonen, T., Anttila, V., Maaranen, P., Niemelä, M., Eskola, M., Ahvenvaara, T., Husso, A., Virtanen, M. P. O., Kinnunen, E.-M., Dahlbacka, S., Jalava, M., Laine, M., Valtola, A., Raivio, P., Vento, A., Airaksinen, J., Mäkikallio, T., & Biancari, F. (2022). Perioperative bleeding requiring blood transfusions is associated with increased risk of stroke after transcatheter and surgical aortic valve replacement. Journal of Cardiothoracic and Vascular Anesthesia, 36(8), 3057–3064.

Perioperative bleeding requiring blood transfusions is associated with increased risk of stroke after transcatheter and surgical aortic valve replacement

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Author: Tauriainen, Tuomas1; Juvonen, Tatu1,2; Anttila, Vesa3;
Organizations: 1Research Unit of Surgery, Anesthesia and Intensive Care, Faculty of Medicine, University of Oulu, Oulu, Finland
2Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
3Heart Center, Department of Surgery, University of Turku, Turku University Hospital, Turku, Finland
4Heart Hospital, Tampere University Hospital and Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
5Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
6Heart Center, Kuopio University Hospital, Kuopio, Finland
7Clinica Montevergine, GVM Care and Research, Mercogliano, Italy
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
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Language: English
Published: Elsevier, 2022
Publish Date: 2022-12-20


Objectives: The authors aimed to investigate the impact of severe bleeding and use of red blood cell (RBC) transfusion on the development of postoperative stroke after surgical (SAVR) and transcatheter aortic valve replacement (TAVR), taken from the FinnValve registry.

Design: Nationwide, retrospective observational study.

Setting: Five Finnish university hospitals participated in the registry.

Participants: A total of 6,463 patients who underwent SAVR (n = 4,333) or TAVR (n = 2,130).

Interventions: Patients who underwent TAVR or SAVR with a bioprosthesis with or without coronary revascularization.

Measurements and Main Results: The incidence of postoperative stroke after SAVR was 3.8%. In multivariate analysis, the number of transfused RBC units (odds ratio [OR], 1.098; 95% confidence interval [CI], 1.064–1.133) was one of the independent predictors of postoperative stroke. The incidence of stroke increased, along with the severity of perioperative bleeding, according to the European Coronary Artery Bypass Grafting (E-CABG) bleeding grades were as follows: grade 0, 2.2% (reference group); grade 1, 3.4% (adjusted OR, 1.841; 95% CI, 1.105–3.066); grade 2, 5.5% (adjusted OR, 3.282; 95% CI, 1.948–5.529); and grade 3, 14.8% (adjusted OR, 7.103; 95% CI, 3.612–13.966). The incidence of postoperative stroke after TAVR was 2.5%. The number of transfused RBC units was an independent predictor of stroke after TAVR (adjusted OR, 1.155; 95% CI, 1.058–1.261). The incidence of postoperative stroke increased, along with the severity of perioperative bleeding, as stratified by the E-CABG bleeding grades: E-CABG grade 0, 1.7%; grade 1, 5.3% (adjusted OR, 1.270; 95% CI, 0.532–3.035); grade 2, 10.0% (adjusted OR, 2.898; 95% CI, 1.101–7.627); and grade 3, 30.0% (adjusted OR, 10.706; 95% CI, 2.389–47.987).

Conclusions: Perioperative bleeding requiring RBC transfusion and/or reoperation for intrathoracic bleeding is associated with an increased risk of postoperative stroke after SAVR and TAVR. Patient blood management and meticulous preprocedural planning and operative technique aiming to avoid significant perioperative bleeding may reduce the risk of cerebrovascular complications.

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Series: Journal of cardiothoracic and vascular anesthesia
ISSN: 1053-0770
ISSN-E: 1532-8422
ISSN-L: 1053-0770
Volume: 36
Issue: 8
Pages: 3057 - 3064
DOI: 10.1053/j.jvca.2022.04.029
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: K.E. Juhani Airaksinen reports research grants from The Finnish Foundation for Cardiovascular Research; the status of speaker for Bayer, Pfizer, and Boehringer-Ingelheim; and status as a member in the advisory boards for Bayer, Pfizer, Astra-Zeneca. Other authors have no conflict of interests to declare.
Copyright information: © 2022 The Author(s). This is an open access article under the CC BY-NC-ND license (