Outcomes of emergent cardiac surgery after transcatheter aortic valve implantation.

Abstract

The aim of this study was to evaluate the reasons for emergent cardiac surgery (ECS) after transcatheter aortic valve implantation (TAVI) and assess outcomes of these patients. All patients undergoing ECS following acomplicated TAVI procedure at ahigh-volume TAVI centre in the Netherlands from 1January 2008 to 1April 2022 were included. Baseline and procedural characteristics and outcome data (procedural, 30-day and 1‑year mortality, in-hospital stroke, 30-day pacemaker implantation, 30-day vascular complications, 30-day deep sternal wound infections and 30-day re-exploration) were collected from patient files and analysed using descriptive statistics. During the study period, 16of 1594 patients (1.0%) undergoing TAVI required ECS. The main reason for ECS was valve embolisation (n = 9; 56.3%), followed by perforation of the left/right ventricle with guide wire/pacemaker lead (n = 3; 18.8%) and annular rupture (n = 3; 18.8%). Procedural, 30-day and 1‑year mortality was 0%, 18.8% (n = 3) and 31.3% (n = 5), respectively. In-hospital stroke occurred in 1patient (6.3%), apacemaker was implanted at 30days in 2patients (12.5%), and major vascular complications did not occur. ECS following complicated TAVI was performed in only asmall number of cases. It had ahigh but acceptable perioperative and 30-day mortality, taking into account the otherwise lethal consequences. In case of valve embolisation, no periprocedural or 30-day mortality was observed for surgical aortic valve replacement (even in aredo setting), which supported the necessity to perform TAVI in centres with cardiac surgical backup on site.