Objective

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.

Methods

All patients undergoing ECS following a complicated TAVI procedure at a high-volume TAVI centre in the Netherlands from 1 January 2008 to 1 April 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.

Results

During the study period, 16 of 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 1 patient (6.3%), a pacemaker was implanted at 30 days in 2 patients (12.5%), and major vascular complications did not occur.

Conclusion

ECS following complicated TAVI was performed in only a small number of cases. It had a high 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 a redo setting), which supported the necessity to perform TAVI in centres with cardiac surgical backup on site.

中文翻译：

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经导管主动脉瓣植入后紧急心脏手术的结果

客观的

本研究的目的是评估经导管主动脉瓣植入（TAVI）后紧急心脏手术（ECS）的原因并评估这些患者的结果。

方法

2008 年 1 月 1 日至 2022 年 4 月 1 日期间，所有在荷兰大容量 TAVI 中心接受复杂 TAVI 手术后接受 ECS 的患者均被纳入。基线和手术特征及结果数据（手术、30 天和 1 年死亡率、院内卒中、30 天起搏器植入、30 天血管并发症、30 天深部胸骨伤口感染和 30 天重新探查） ）从患者档案中收集并使用描述性统计进行分析。

结果

研究期间，1594 名接受 TAVI 的患者中有 16 名 (1.0%) 需要 ECS。ECS 的主要原因是瓣膜栓塞 ( n  = 9; 56.3%)，其次是导丝/起搏器导线导致左/右心室穿孔 ( n  = 3; 18.8%) 和瓣环破裂 ( n  = 3; 18.8%) ）。手术死亡率、30 天死亡率和 1 年死亡率分别为 0%、18.8% ( n  = 3) 和 31.3% ( n  = 5)。院内卒中1例（6.3%），起搏器植入30天2例（12.5%），未发生大血管并发症。

结论

只有少数病例在复杂的 TAVI 后进行了 ECS。考虑到其他致命后果，其围手术期和 30 天死亡率较高，但可以接受。在发生瓣膜栓塞的情况下，没有观察到主动脉瓣置换术的围手术期或 30 天死亡率（即使在重做情况下），这支持了在现场有心脏外科备用中心的中心进行 TAVI 的必要性。