1. 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)
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Alfredo Giuseppe Cerillo, Darren Mylotte, Piotr Szymański, Katarzyna Czerwińska-Jelonkiewicz, Julinda Mehilli, Holger Eggebrecht, Marco Spaziano, Uri Landes, Sabine Bleiziffer, Joachim Schofer, Tanja K. Rudolph, Antti Siljander, Christian Hengstenberg, Andreas Zierer, Jörg Kempfert, Moritz Seiffert, Fausto Biancari, Eduardo Bossone, Raphael Philippart, Christoph Naber, Rajendra H. Mehta, Ran Kornowski, Won-Keun Kim, Augusto D'Onofrio, Dennis Eckner, Thibault Lhermusier, Lars Søndergaard, Beatriz Vaquerizo, Ole De Backer, Alaide Chieffo, Carl Kaulfersch, Charles Cornet, Smita Scholtz, Thomas Walther, César Morís, Thierry Lefèvre, Martin Czerny, Johannes Lammer, Daniel J. Blackman, Philipp Kahlert, Holger Schröfel, Eggebrecht, H, Vaquerizo, B, Moris, C, Bossone, E, Lammer, J, Czerny, M, Zierer, A, Schrofel, H, Kim, Wk, Walther, T, Scholtz, S, Rudolph, T, Hengstenberg, C, Kempfert, J, Spaziano, M, Lefevre, T, Bleiziffer, S, Schofer, J, Mehilli, J, Seiffert, M, Naber, C, Biancari, F, Eckner, D, Cornet, C, Lhermusier, T, Philippart, R, Siljander, A, Cerillo, Ag, Blackman, D, Chieffo, A, Kahlert, P, Czerwinska-Jelonkiewicz, K, Szymanski, P, Landes, U, Kornowski, R, D'Onofrio, A, Kaulfersch, C, Sondergaard, L, Mylotte, D, Mehta, Rh, and De Backer, O
- Subjects
Male ,medicine.medical_specialty ,Complications ,Transcatheter aortic ,Aged ,Aged, 80 and over ,Aortic Valve Stenosis ,Cardiac Surgical Procedures ,Emergency Treatment ,Europe ,Female ,Hospital Mortality ,Humans ,Incidence ,Registries ,Risk Assessment ,Transcatheter Aortic Valve Replacement ,Perforation (oil well) ,Medizin ,TAVR ,030204 cardiovascular system & hematology ,TAVI ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,80 and over ,Medicine ,030212 general & internal medicine ,business.industry ,Incidence (epidemiology) ,Conversion ,Odds ratio ,ta3121 ,medicine.disease ,Confidence interval ,Cardiac surgery ,Death ,Aortic valve stenosis ,Cardiology ,Surgery ,Ventricular Perforation ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims: Life-threatening complications occur during transcatheter aortic valve implantation (TAVI) which can require emergent cardiac surgery (ECS). Risks and outcomes of patients needing ECS during or immediately after TAVI are still unclear. Methods and results: Incidence, risk factors, management, and outcomes of patients requiring ECS during transfemoral (TF)-TAVI were analysed from a contemporary real-world multicentre registry. Between 2013 and 2016, 27 760 patients underwent TF-TAVI in 79 centres. Of these, 212 (0.76%) patients required ECS (age 82.4 ± 6.3 years, 67.5% females, logistic EuroSCORE: 17.1%, STS-score 5.8%). The risk of ECS declined from 2013 (1.07%) to 2014 (0.70%) but remained stable since. Annual TF-TAVI numbers have more than doubled from 2013 to 2016. Leading causes for ECS were left ventricular perforation by the guidewire (28.3%) and annular rupture (21.2%). Immediate procedural mortality ( 85 years [odds ratio (OR) 1.87, 95% confidence interval (95% CI) (1.02–3.45), P = 0.044], annular rupture [OR 1.96, 95% CI (0.94–4.10), P = 0.060], and immediate ECS [OR 3.12, 95% CI (1.07–9.11), P = 0.037]. One year of survival of the 114 patients surviving the in-hospital period was only 40.4%. Conclusion: Between 2014 and 2016, the need for ECS remained stable around 0.7%. Left ventricular guidewire perforation and annular rupture were the most frequent causes, accounting for almost half of ECS cases. Half of the patients could be salvaged by ECS—nevertheless, 1 year of all-cause mortality was high even in those ECS patients surviving the in-hospital period.
- Published
- 2017
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