Incidence and Outcomes of Emergency Intraprocedural Surgical Conversion During TAVI: A Multicentric Analysis

Thursday, July 11, 2024

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Source

Source Name: Journal of the American Heart Association

Source URL: https://www.ahajournals.org/doi/full/10.1161/JAHA.123.033964

Author(s)

Mateo Marin‐Cuartas, Suzanne de Waha, Manuela de la Cuesta, Salil V. Deo, Alexander Kaminski, Andreas Fach, Anna L. Meyer, Aron‐Frederik Popov, , Christian Hagl, Dominik Joskowiak, Elmar W. Kuhn, Fabio Ius, Florian Leuschner, George Awad, Holger Thiele, Ali Abdalla, Jens Garbade, Joerg Ender, Katharina Wehrmann, Kaveh Eghbalzadeh, Keti Vitanova, Lenard Conradi, Mahmoud Diab, Marcus Franz, Martin Geyer, Massimiliano Meineri, Martin Misfeld, Mohamed Abdel‐Wahab, Oliver D. Bhadra, Rico Osteresch, Rodrigo Sandoval Boburg, Rüdiger Lange, Sergey Leontyev, Shekhar Saha, Steffen Desch, Sven Lehmann, Thilo Noack, Torsten Doenst, Michael A. Borger, and Philipp Kiefer

The number of patients at intermediate and low surgical risk treated by transcatheter aortic valve implantation (TAVI) is rapidly increasing. Current guidelines recommend performing TAVI in heart valve centers with surgical backup. Nonetheless, there is an ongoing discussion about possibly abrogating on‐site surgical backup for TAVI procedures to increase accessibility. However, concerns and uncertainty exist about the safety of performing TAVI in nonsurgical centers.

This collaborative effort, using pooled data from 14 German centers, presents contemporary outcomes of patients undergoing emergency open-heart surgery (E-OHS) due to severe intraprocedural complications during elective transfemoral TAVI.

The authors conclude that in the setting of a heart team approach with immediate surgical backup, E‐OHS due to potentially lethal TAVI complications is not a futile clinical situation, with acceptable short‐ and long‐term outcomes, especially in low and intermediate-risk patients.

Comments

Submitted by Mario Matos-Cruz on Sat, 2024-07-13 21:58

I have been summoned to assist surgical rescue on 3 TAVR patients with aortic perforation due to impaled calcium thru aortic wall during Edwards valve deployment. Advanced CPR compressions done but because of arterial pressurization of pericardial sac I do not think that effective cerebral perfusion achieved. Emergency veno-arterial ECMO Fem-Fem instituted Cardioplegic arrest and repair of aorta done and surgical valve placed. All 3 patients came off CPB but none of them survived due to being brain dead. Unless the ECMO cannulas and circuit can be instituted in less than 5 minutes or they are in place when complication occurs so that you just turn on ECMO system on as soon as perforation occurs, I don't have much hopes any patient will actually survive neurologically due to inefficient CPR due to pericardial tamponade..