Abstract 204: Comparison of Hemodynamic Parameters and Clinical Outcomes in Jehovah’s Witness Patients versus Non-Jehovah’s Witness Patients Undergoing Transcatheter Aortic Valve Replacement

Abstract

Background: Surgical aortic valve replacement may be complicated by significant perioperative bleeding. TAVR is a less invasive procedure, however bleeding may still occur related to periprocedural complications and anti-thrombotic therapy. We sought to compare baseline characteristics, hemodynamic parameters and clinical outcomes following TAVR between Jehovah’s witness (JW) patients who decline the use of blood products, and non-JW patients. Methods: Demographic, echocardiographic, and hemodynamic data of 245 consecutive patients with symptomatic severe aortic stenosis who underwent TAVR at our institution between January 2013 and December 2015 were analyzed at baseline and at 30 day follow-up. Results: 10 patients were identified as JW refusing blood transfusion. None of the JW patients received blood products. JW and non-JW patients did not differ in respect to hemodynamic or echocardiographic parameters at baseline or 30 days post TAVR, including: blood pressure, heart rate, valve area, gradient, valvuloarterial impedance, cardiac output, stroke volume and ejection fraction. Baseline hemoglobin was higher in the JW versus non-JW groups, respectively (12.76 vs. 11.62 mg/dL p=0.045) and this was sustained at follow-up. Clinical outcomes were similar at 30 days between JW and non-JW patients, notably major bleed (10% vs 8.97%, respectively; p=0.91, defined as a clinical bleeding event with hemoglobin decrease > 2g/dL or transfusion of > 2 units of whole blood/red cells ) and 30 day mortality (0% vs 6.41%, respectively; p=0.19). Conclusion: JW patients were found to have similar hemodynamic and clinical outcomes up to 30 days. TAVR may be considered a reasonable treatment option for patients with symptomatic severe aortic stenosis who refuse transfusion of blood products.