• Tuomas Tauriainen, Tatu Juvonen, Vesa Anttila, Pasi Maaranen, Matti Niemelä, Markku Eskola, Tuomas Ahvenvaara, Annastiina Husso, Marko P O Virtanen, Eeva-Maija Kinnunen, Sebastian Dahlbacka, Maina Jalava, Mika Laine, Antti Valtola, Peter Raivio, Antti Vento, Juhani Airaksinen, Timo Mäkikallio, and Fausto Biancari.
• Research Unit of Surgery, Anesthesia and Intensive Care, Faculty of Medicine, University of Oulu, Oulu, Finland. Electronic address: tuomas.ttau@gmail.com.
• J. Cardiothorac. Vasc. Anesth. 2022 Aug 1; 36 (8 Pt B): 3057-3064.

ObjectivesThe 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.DesignNationwide, retrospective observational study.SettingFive Finnish university hospitals participated in the registry.ParticipantsA total of 6,463 patients who underwent SAVR (n = 4,333) or TAVR (n = 2,130).InterventionsPatients who underwent TAVR or SAVR with a bioprosthesis with or without coronary revascularization.Measurements And Main ResultsThe 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).ConclusionsPerioperative 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.Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

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