TY - JOUR

T1 - Incidence and outcomes of emergent cardiac surgery during transfemoral transcatheter aortic valve implantation (TAVI)

T2 - Insights from the e uropean R egistry on e mergent C ardiac S urgery during TAVI (EuRECS-TAVI)

AU - Eggebrecht, Holger

AU - Vaquerizo, Beatriz

AU - Moris, Cesar

AU - Bossone, Eduardo

AU - Lämmer, Johannes

AU - Czerny, Martin

AU - Zierer, Andreas

AU - Schröfel, Holger

AU - Kim, Won Keun

AU - Walther, Thomas

AU - Scholtz, Smita

AU - Rudolph, Tanja

AU - Hengstenberg, Christian

AU - Kempfert, Jörg

AU - Spaziano, Marco

AU - Lefevre, Thierry

AU - Bleiziffer, Sabine

AU - Schofer, Joachim

AU - Mehilli, Julinda

AU - Seiffert, Moritz

AU - Naber, Christoph

AU - Biancari, Fausto

AU - Eckner, Dennis

AU - Cornet, Charles

AU - Lhermusier, Thibault

AU - Philippart, Raphael

AU - Siljander, Antti

AU - Giuseppe Cerillo, Alfredo

AU - Blackman, Daniel

AU - Chieffo, Alaide

AU - Kahlert, Philipp

AU - Czerwinska-Jelonkiewicz, Katarzyna

AU - Szymanski, Piotr

AU - Landes, Uri

AU - Kornowski, Ran

AU - D'Onofrio, Augusto

AU - Kaulfersch, Carl

AU - Søndergaard, Lars

AU - Mylotte, Darren

AU - Mehta, Rajendra H.

AU - De Backer, Ole

PY - 2018

Y1 - 2018

N2 - Aims Life-threatening complications occur during transcatheter aortic valve implantation (TAVI) which can require emergent cardiac surgery (ECS). Risks and outcomes of patients needing ECS during or immediately after TAVI are still unclear. Methods and results Incidence, risk factors, management, and outcomes of patients requiring ECS during transfemoral (TF)-TAVI were analysed from a contemporary real-world multicentre registry. Between 2013 and 2016, 27 760 patients underwent TF-TAVI in 79 centres. Of these, 212 (0.76%) patients required ECS (age 82.4 ± 6.3 years, 67.5% females, logistic EuroSCORE: 17.1%, STS-score 5.8%). The risk of ECS declined from 2013 (1.07%) to 2014 (0.70%) but remained stable since. Annual TF-TAVI numbers have more than doubled from 2013 to 2016. Leading causes for ECS were left ventricular perforation by the guidewire (28.3%) and annular rupture (21.2%). Immediate procedural mortality (<72 h) of TF-TAVI patients requiring ECS was 34.6%. Overall in-hospital mortality was 46.0%, and highest in case of annular rupture (62%). Independent predictors of in-hospital mortality following ECS were age > 85 years [odds ratio (OR) 1.87, 95% confidence interval (95% CI) (1.02-3.45), P = 0.044], annular rupture [OR 1.96, 95% CI (0.94-4.10), P = 0.060], and immediate ECS [OR 3.12, 95% CI (1.07-9.11), P = 0.037]. One year of survival of the 114 patients surviving the in-hospital period was only 40.4%. Conclusion Between 2014 and 2016, the need for ECS remained stable around 0.7%. Left ventricular guidewire perforation and annular rupture were the most frequent causes, accounting for almost half of ECS cases. Half of the patients could be salvaged by ECS - nevertheless, 1 year of all-cause mortality was high even in those ECS patients surviving the in-hospital period.

AB - Aims Life-threatening complications occur during transcatheter aortic valve implantation (TAVI) which can require emergent cardiac surgery (ECS). Risks and outcomes of patients needing ECS during or immediately after TAVI are still unclear. Methods and results Incidence, risk factors, management, and outcomes of patients requiring ECS during transfemoral (TF)-TAVI were analysed from a contemporary real-world multicentre registry. Between 2013 and 2016, 27 760 patients underwent TF-TAVI in 79 centres. Of these, 212 (0.76%) patients required ECS (age 82.4 ± 6.3 years, 67.5% females, logistic EuroSCORE: 17.1%, STS-score 5.8%). The risk of ECS declined from 2013 (1.07%) to 2014 (0.70%) but remained stable since. Annual TF-TAVI numbers have more than doubled from 2013 to 2016. Leading causes for ECS were left ventricular perforation by the guidewire (28.3%) and annular rupture (21.2%). Immediate procedural mortality (<72 h) of TF-TAVI patients requiring ECS was 34.6%. Overall in-hospital mortality was 46.0%, and highest in case of annular rupture (62%). Independent predictors of in-hospital mortality following ECS were age > 85 years [odds ratio (OR) 1.87, 95% confidence interval (95% CI) (1.02-3.45), P = 0.044], annular rupture [OR 1.96, 95% CI (0.94-4.10), P = 0.060], and immediate ECS [OR 3.12, 95% CI (1.07-9.11), P = 0.037]. One year of survival of the 114 patients surviving the in-hospital period was only 40.4%. Conclusion Between 2014 and 2016, the need for ECS remained stable around 0.7%. Left ventricular guidewire perforation and annular rupture were the most frequent causes, accounting for almost half of ECS cases. Half of the patients could be salvaged by ECS - nevertheless, 1 year of all-cause mortality was high even in those ECS patients surviving the in-hospital period.

KW - Complications

KW - Conversion

KW - Death

KW - Surgery

KW - TAVI

KW - TAVR

U2 - 10.1093/eurheartj/ehx713

DO - 10.1093/eurheartj/ehx713

M3 - Journal article

C2 - 29253177

AN - SCOPUS:85042608097

VL - 39

SP - 676

EP - 684

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 8

ER -