Short-term results of emergency conversion to surgery during transcatheter aortic valve replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LU Qilin ¹ , ZHANG Jieqiong ² , AN Jinghui ² , LIU Su ² , MA Qianli ² ,  SHI Fengwu ²

1. Graduate School, Hebei Medical University, Shijiazhuang, 050011, P. R. China;
2. Department of Cardiovascular Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050004, P. R. China;

Corresponding author：

SHI Fengwu, Email: shifengwu65@163.com

Keywords：

Transcatheter aortic valve replacement; surgery; complications

DOI：

10.7507/1007-4848.202306033

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To analyze the short-term clinical outcomes of emergency conversion to surgery during transcatheter aortic valve replacement (TAVR). Methods Clinical data of patients who underwent emergency surgical conversion from TAVR in the Department of Cardiovascular Surgery, the Second Hospital of Hebei Medical University, from 2018 to 2023 were collected. Postoperative follow-up results at 1 month were recorded. Results A total of 253 patients underwent TAVR, of whom 11 (4.3%) required emergency conversion to surgery. Among these 11 patients, 7 were male and 4 were female, with a mean age of (69.55±5.01) years. The primary cause for emergency surgical conversion was valve stent displacement (63.6%), followed by left ventricular perforation/rupture (18.2%) and significant perivalvular regurgitation persisting after a second valve implantation (18.2%). One (9.1%) patient died intraoperatively. Among the 10 surviving patients, postoperative complications included pulmonary infection in 8 patients, severe pneumonia in 7, pleural effusion in 3, liver dysfunction in 8, renal dysfunction in 3, upper gastrointestinal bleeding in 5, cerebrovascular complications in 1, atrial fibrillation in 1, ventricular premature contractions in 1, atrioventricular block in 1, and complete left bundle branch block in 3. At 1-month postoperative follow-up, one additional patient died, yielding a 30-day mortality rate of 18.2% after TAVR emergency surgical conversion. The quality of life improved significantly compared to preoperative status in 9 (81.8%) patients, and no patients were readmitted for cardiovascular diseases. Conclusion The incidence of emergency conversion to surgery during TAVR is low, but the rates of surgical complications and 30-day postoperative mortality are high. Nevertheless, when severe complications occur during TAVR, emergency conversion to surgery can still yield satisfactory short-term clinical outcomes for a majority of these patients.

1.	Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation, 2002, 106(24): 3006-3008.
2.	Bowdish ME, D'Agostino RS, Thourani VH, et al. STS adult cardiac surgery database: 2021 update on outcomes, quality, and research. Ann Thorac Surg, 2021, 111(6): 1770-1780.
3.	刘鹏, 鲍贤豪, 马孝琛, 等. 经导管主动脉瓣置换术术后并发症及其治疗进展. 血管与腔内血管外科杂志, 2022, 8(9): 1093-1098.Liu P, Bao XH, Ma XC, et al. Postoperative complications and treatment progress of transcatheter aortic valve replacement. J Vasc Endovasc Surg, 2022, 8(9): 1093-1098.
4.	Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
5.	Griese DP, Reents W, Kerber S, et al. 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): E726-E733.
6.	Lange R, Bleiziffer S, Piazza N, et al. Incidence and treatment of procedural cardiovascular complications associated with trans-arterial and trans-apical interventional aortic valve implantation in 412 consecutive patients. Eur J Cardiothorac Surg, 2011, 40(5): 1105-1113.
7.	Seiffert M, Conradi L, Baldus S, et al. Severe intraprocedural complications after transcatheter aortic valve implantation: calling for a heart team approach. Eur J Cardiothorac Surg, 2013, 44(3): 478-484.
8.	Eggebrecht H, Schmermund A, Kahlert P, et al. Emergent cardiac surgery during transcatheter aortic valve implantation (TAVI): a weighted meta-analysis of 9, 251 patients from 46 studies. EuroIntervention, 2013, 8(9): 1072-1080.
9.	Nielsen NE, Baranowska J, Bramlage P, et al. Minimizing the risk for left ventricular rupture during transcatheter aortic valve implantation by reducing the presence of stiff guidewires in the ventricle. Interact Cardiovasc Thorac Surg, 2019, 29(3): 365-370.
10.	Li F, Wang X, Wang Y, et al. Short- and long-term outcome after emergent cardiac surgery during transcatheter aortic valve implantation. Ann Thorac Cardiovasc Surg, 2021, 27(2): 112-118.
11.	Zahn R, Gerckens U, Grube E, et al. Transcatheter aortic valve implantation: first results from a multi-centre real-world registry. Eur Heart J, 2011, 32(2): 198-204.

1. Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation, 2002, 106(24): 3006-3008.
2. Bowdish ME, D'Agostino RS, Thourani VH, et al. STS adult cardiac surgery database: 2021 update on outcomes, quality, and research. Ann Thorac Surg, 2021, 111(6): 1770-1780.
3. 刘鹏, 鲍贤豪, 马孝琛, 等. 经导管主动脉瓣置换术术后并发症及其治疗进展. 血管与腔内血管外科杂志, 2022, 8(9): 1093-1098.Liu P, Bao XH, Ma XC, et al. Postoperative complications and treatment progress of transcatheter aortic valve replacement. J Vasc Endovasc Surg, 2022, 8(9): 1093-1098.
4. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
5. Griese DP, Reents W, Kerber S, et al. 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): E726-E733.
6. Lange R, Bleiziffer S, Piazza N, et al. Incidence and treatment of procedural cardiovascular complications associated with trans-arterial and trans-apical interventional aortic valve implantation in 412 consecutive patients. Eur J Cardiothorac Surg, 2011, 40(5): 1105-1113.
7. Seiffert M, Conradi L, Baldus S, et al. Severe intraprocedural complications after transcatheter aortic valve implantation: calling for a heart team approach. Eur J Cardiothorac Surg, 2013, 44(3): 478-484.
8. Eggebrecht H, Schmermund A, Kahlert P, et al. Emergent cardiac surgery during transcatheter aortic valve implantation (TAVI): a weighted meta-analysis of 9, 251 patients from 46 studies. EuroIntervention, 2013, 8(9): 1072-1080.
9. Nielsen NE, Baranowska J, Bramlage P, et al. Minimizing the risk for left ventricular rupture during transcatheter aortic valve implantation by reducing the presence of stiff guidewires in the ventricle. Interact Cardiovasc Thorac Surg, 2019, 29(3): 365-370.
10. Li F, Wang X, Wang Y, et al. Short- and long-term outcome after emergent cardiac surgery during transcatheter aortic valve implantation. Ann Thorac Cardiovasc Surg, 2021, 27(2): 112-118.
11. Zahn R, Gerckens U, Grube E, et al. Transcatheter aortic valve implantation: first results from a multi-centre real-world registry. Eur Heart J, 2011, 32(2): 198-204.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesShort-term results of emergency conversion to surgery during transcatheter aortic valve replacement

Abstract Full text Figures/Tables Video References Cited by

Format

Content