Emergency cardiac surgery during transfemoral and transapical transcatheter aortic valve implantation: Incidence, reasons, management, and outcome of 411 patients from a single center

• Published in: Catheterization and cardiovascular interventions 2013-11, Vol.82 (5), p.E726-E733
• Main Authors: Griese, Daniel P., Reents, Wilko, Kerber, Sebastian, Diegeler, Anno, Babin-Ebell, Jörg
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Cardiac Catheterization - adverse effects; Cardiac Catheterization - methods; Cardiac Catheterization - mortality; Cardiopulmonary Bypass; cardiopulmonary support; complications adult cath/intervention; Emergencies; Female; Femoral Artery; Germany; Heart Injuries - diagnosis; Heart Injuries - mortality; Heart Injuries - surgery; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - mortality; Hospital Mortality; Humans; Incidence; Kaplan-Meier Estimate; Male; Patient Discharge; Proportional Hazards Models; Risk Factors; Severity of Illness Index; Suture Techniques; Thoracotomy; Time Factors; Treatment Outcome; valvular heart disease
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.25049

Objectives and Background Transcatheter aortic valve implantation (TAVI) is increasingly performed in high‐risk patients with severe aortic valve stenosis. Incidence and impact of emergency cardiac surgery (ECS) during TAVI is unclear. Methods and Results Two‐hundred twenty one transapical (TA) and 190 transfemoral (TF) TAVIs were performed at our hospital between 01/2009 and 12/2012. Twenty patients (4.9%) required ECS, more frequently in the TF‐ (n = 11; 5.8%) than in the TA‐group (n = 9; 4.1%; P = 0.017). ECS‐cases were evenly distributed throughout the 4 years. Baseline characteristics of the ECS‐patients were not different from the non‐ECS‐patients. Reasons were acute cardiac failure, coronary obstruction, annular rupture, valve migration, right‐ and left‐ventricular perforation, severe paravalvular leakage, aortic dissection, and mitral valve damage. Surgical intervention consisted of peripheral CPB, switch to TA, thoracotomy and suture of perforated cardiac chambers and conventional aortic valve replacement with concomitant repair of associated cardiovascular injury. Thirty‐day mortality was 35.0%, and 55.0% could be salvaged to hospital discharge. Kaplan–Meier 1‐year survival curves were significantly impaired for patients requiring ECS (TF: P