Subsequent cardiac surgery after transcatheter aortic valve implantation: Indications and outcomes.

Fagu, Albi; Siepe, Matthias; Uzdenov, Murat; Dees, Dominik; Kondov, Stoyan; Beyersdorf, Friedhelm; Rylski, Bartosz; Czerny, Martin; Neumann, Franz-Josef; Kreibich, Maximilian; Berger, Tim (2022). Subsequent cardiac surgery after transcatheter aortic valve implantation: Indications and outcomes. Journal of cardiac surgery, 37(12), pp. 5187-5194. Wiley-Blackwell 10.1111/jocs.17219

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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

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

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

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.

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