Incidence and Outcomes of Emergent Intraprocedural Surgical Conversion during Transcatheter Aortic Valve Implantation: Insights from a Multicentric Germany-Wide Analysis

Background: In transcatheter aortic valve implantation (TAVI), intraprocedural complications which are only manageable by conversion to emergent open-heart surgery (E-OHS) occasionally occur. Contemporary data on the incidence and outcome following E-OHS in TAVI patients are scarce. This study aims to evaluate the early outcomes after emergent intraprocedural conversion to open-heart surgery (OHS) in patients undergoing TAVI.

Method: This is a retrospective multicentric analysis including 14 German centers. Patients who required E-OHS during a TAVI procedure between 2009 and 2021 were included in the analysis. Patients who underwent non-transfemoral TAVI and critical patients with nonelective TAVI were excluded from the analysis. Primary outcomes were intraprocedural and in-hospital mortality as well as 1-year survival.

Results: During the study period, a total of 41,768 patients underwent TAVI. Among them, 216 (0.5%) required E-OHS. A total of 152 patients were included in the analysis (65 patients met exclusion criteria). Mean age was 80.9 (±6.9) years and 94 (61.8%) were female. Median EuroSCORE II was 7.2% (3.5–14.7%) (low/intermediate risk: 55 [36.2%] patients; high-risk: 97 [63.8%] patients). The most common indications for conversion were: valve failure/dislocation 49 (32.2%), left ventricular perforation 46 (30.3%), aortic annular rupture 34 (22.4%), and aortic dissection 20 (13.2%). Intraprocedural mortality occurred in 18 patients (11.8%). In-hospital mortality was 47.4% in the whole cohort (55.8% in high-risk patients and 33.3% in low/intermediate-risk patients [p = 0.007]). One-year survival was 55.5% in all patients undergoing E-OHS, 39.5% in high-risk patients, and 61.3% in low/intermediate-risk patients (p < 0.001). One-year survival was 58.9% in patients <80 years and 40.1% in patients >80 years (p = 0.009). Chronic kidney disease (OR: 1.2, 95% CI: 1.0–1.5, p = 0.04) and liver disease (OR: 1.7, 95% CI: 1.1–2.7, p = 0.01) were identified as independent predictors of mortality.

Conclusion: The need for conversion to E-OHS during TAVI is infrequent. E-OHS in-hospital and 1-year survival rates are much higher for low/intermediate risk than high risk patients. Given the high lethality of some TAVI complications, on-site cardiac surgery with immediately available E-OHS capabilities is an important component of the TAVI team, particularly in low/intermediate risk patients.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
28 January 2023