Subsequent cardiac surgery after transcatheter aortic valve implantation: Indications and outcomes.
Open surgery after TAVI
aortic valve
aortic valve intervention
emergency conversions
reoperation after TAVI
subsequent cardiac surgery
transcatheter aortic valve implantation
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Dec 2022
Dec 2022
Historique:
revised:
30
10
2022
received:
04
09
2022
accepted:
01
11
2022
pubmed:
16
11
2022
medline:
6
1
2023
entrez:
15
11
2022
Statut:
ppublish
Résumé
Aim of this study was to report on indications and clinical outcomes of patients who underwent subsequent open-cardiac surgery after transcatheter aortic valve implantation TAVI. Between 01/2011 and 12/2020 our centre performed 4043 TAVI procedures. Twenty-seven patients (including patients in whom TAVI was performed in other centres) underwent subsequent open-heart surgery via cardiopulmonary bypass. Demographic, intraprocedural data, indications for, and outcomes after surgery were evaluated. Indications for cardiac surgery (aged 79 [IQR 76-84]; 59.3% male) were endocarditis (n = 11; 40.7%), annular rupture, severe paravalvular leak and severe stenosis in three (11.1%) patients, respectively as well as in one patient each (3.7%) severe tricuspid valve regurgitation, valve thrombosis, valve malposition, valve migration, ostial right coronary artery obstruction, left ventricular rupture and type A aortic dissection. The interval between the index TAVI procedure to open surgery was 3 months (IQR 0-26 months). Eight patients underwent emergent surgical conversions. Immediate procedural and procedural mortality was 25.9% and 40.7%, respectively and all-cause mortality was 51.9% (11/12 died for cardiovascular reasons). No disabling stroke was observed postoperatively. New permanent pacemaker implantation was required in three patients (11.1%). Subsequent open-cardiac surgery after TAVI is rare, but may urgently become necessary due to TAVI related complications or progressing other cardiac pathologies. Despite a substantial early attrition rate clinical outcome is acceptable and a relevant number of these high-risk patients can be discharged even after emergency conversions. The option of subsequent surgical conversion remains.
Sections du résumé
BACKGROUND
BACKGROUND
Aim of this study was to report on indications and clinical outcomes of patients who underwent subsequent open-cardiac surgery after transcatheter aortic valve implantation TAVI.
METHODS
METHODS
Between 01/2011 and 12/2020 our centre performed 4043 TAVI procedures. Twenty-seven patients (including patients in whom TAVI was performed in other centres) underwent subsequent open-heart surgery via cardiopulmonary bypass. Demographic, intraprocedural data, indications for, and outcomes after surgery were evaluated.
RESULTS
RESULTS
Indications for cardiac surgery (aged 79 [IQR 76-84]; 59.3% male) were endocarditis (n = 11; 40.7%), annular rupture, severe paravalvular leak and severe stenosis in three (11.1%) patients, respectively as well as in one patient each (3.7%) severe tricuspid valve regurgitation, valve thrombosis, valve malposition, valve migration, ostial right coronary artery obstruction, left ventricular rupture and type A aortic dissection. The interval between the index TAVI procedure to open surgery was 3 months (IQR 0-26 months). Eight patients underwent emergent surgical conversions. Immediate procedural and procedural mortality was 25.9% and 40.7%, respectively and all-cause mortality was 51.9% (11/12 died for cardiovascular reasons). No disabling stroke was observed postoperatively. New permanent pacemaker implantation was required in three patients (11.1%).
CONCLUSIONS
CONCLUSIONS
Subsequent open-cardiac surgery after TAVI is rare, but may urgently become necessary due to TAVI related complications or progressing other cardiac pathologies. Despite a substantial early attrition rate clinical outcome is acceptable and a relevant number of these high-risk patients can be discharged even after emergency conversions. The option of subsequent surgical conversion remains.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
5187-5194Informations de copyright
© 2022 The Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC.
Références
Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363(17):1597-1607.
Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J [Internet]. 2021. doi:10.1093/eurheartj/ehab395/6358470https://academic.oup.com/eurheartj/advance-article/
Jawitz OK, Gulack BC, Grau-Sepulveda MV, et al. Reoperation after transcatheter aortic valve replacement: an analysis of the Society of Thoracic Surgeons Database. JACC Cardiovasc Interv. 2020;13(13):1515-1525.
Eggebrecht H, Vaquerizo B, Moris C, et al. Incidence and outcomes of emergent cardiac surgery during transfemoral transcatheter aortic valve implantation (TAVI): insights from the European Registry on Emergent Cardiac Surgery during TAVI (EuRECS-TAVI). Eur Heart J. 2018;39(8):676-684.
Kappetein AP, Head SJ, Généreux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Thorac Cardiovasc Surg. 2013;145(1):6-23.
Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European Society of Cardiology (ESC). endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36(44):3075-3128.
Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380(18):1695-1705.
Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med. 2019;380(18):1706-1715.
Barbanti M, Webb JG, Hahn RT, et al. Impact of preoperative moderate/severe mitral regurgitation on 2-year outcome after transcatheter and surgical aortic valve replacement: insight from the Placement of Aortic Transcatheter Valve (PARTNER) Trial Cohort A. Circulation. 2013;128(25):2776-2784.
Moazami N, Diodato MD, Moon MR, et al. Does functional mitral regurgitation improve with isolated aortic valve replacement? J Card Surg. 2004;19(5):444-448.
Eggebrecht H, Mehta RH, Kahlert P, et al. Emergent cardiac surgery during transcatheter aortic valve implantation (TAVI): insights from the Edwards SAPIEN Aortic Bioprosthesis European Outcome (SOURCE) registry. EuroIntervention. 2014;10(8):975-981.
Griese DP, Reents W, Kerber S, Diegeler A, Babin-Ebell J. Emergency cardiac surgery during transfemoral and transapical transcatheter aortic valve implantation: incidence, reasons, management, and outcome of 411 patients from a single center. Catheter Cardiovasc Interv. 2013;82(5):726-733.
Sathananthan J, Lauck S, Polderman J, et al. Ten year follow-up of high-risk patients treated during the early experience with transcatheter aortic valve replacement. Catheter Cardiovasc Interv. 2021;97(3):431-7.
Eggebrecht H, Bestehorn M, Haude M, et al. Outcomes of transfemoral transcatheter aortic valve implantation at hospitals with and without on-site cardiac surgery department: insights from the prospective German aortic valve replacement quality assurance registry (AQUA) in 17 919 patients. Eur Heart J. 2016;37(28):2240-2248.
Vannini L, Andrea R, Sabaté M. Conservative management of aortic root rupture complicated with cardiac tamponade following transcatheter aortic valve implantation. World J Cardiol. 2017;9(4):391-395.
Ravindran M, Henning KA, Qiu F, et al. Predictors of long-term cardiovascular versus non-cardiovascular mortality and repeat intervention in patients having transcatheter aortic valve implantation. Am J Cardiol. 2020;135(135):105-112.
Amat-Santos IJ, Messika-Zeitoun D, Eltchaninoff H, et al. Infective endocarditis after transcatheter aortic valve implantation: results from a large multicenter registry. Circulation. 2015;131(18):1566-1574.
Mangner N, Woitek F, Haussig S, et al. Incidence, predictors, and outcome of patients developing infective endocarditis following transfemoral transcatheter aortic valve replacement. J Am Coll Cardiol. 2016;67(24):2907-2908.
Tornos P, Lung B, Permanyer-Miralda G, et al. Infective endocarditis in Europe: lessons from the Euro heart survey. Heart. 2005;91(5):571-575.
Regueiro A, Linke A, Latib A, et al. Infective endocarditis following transcatheter aortic valve replacement: comparison of balloon-versus self-expandable valves. Circ Cardiovasc Interv. 2019;12(11):e007938.