Holger Eggebrecht1,2, Beatriz Vaquerizo3, Cesar Moris4, Eduardo Bossone5, Johannes Lämmer1, Martin Czerny6, Andreas Zierer7, Holger Schröfel6, Won-Keun Kim8, Thomas Walther8, Smita Scholtz9, Tanja Rudolph10, Christian Hengstenberg11, Jörg Kempfert12, Marco Spaziano13, Thierry Lefevre13, Sabine Bleiziffer14, Joachim Schofer15, Julinda Mehilli16, Moritz Seiffert17, Christoph Naber18, Fausto Biancari19, Dennis Eckner20, Charles Cornet21, Thibault Lhermusier22, Raphael Philippart23, Antti Siljander24, Alfredo Giuseppe Cerillo25, Daniel Blackman26, Alaide Chieffo27, Philipp Kahlert28, Katarzyna Czerwinska-Jelonkiewicz29, Piotr Szymanski30, Uri Landes31, Ran Kornowski31, Augusto D'Onofrio32, Carl Kaulfersch33, Lars Søndergaard34, Darren Mylotte35, Rajendra H Mehta36, Ole De Backer34. 1. Department of Cardiology, Cardioangiologisches Centrum Bethanien (CCB) at the AGAPLESION Bethanien Hospital, Im Prüfling 21-25, 60389 Frankfurt, Germany. 2. Department of Cardiology, Herz- Thorax- Zentrum, Klinikum Fulda, Pacelliallee 4, 36043 Fulda, Germany. 3. Unidad de Cardiología Intervencionista, Departamento de Cardiología, Hospital del Mar, Passeig Marítim 25/29, 08003 Barcelona, Spain. 4. Área del Corazón, Hospital Universitario Central de Asturias, Roma s/n, 33011 Oviedo, Asturias, Spain. 5. Cardiology Division "Cava de'Tirreni and Amalfi Coast" Heart Department, University Hospital, Via de Marinis 4, 84013 Cava de'Tirreni, Italy. 6. Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany. 7. Department of Thoracic and Cardiovascular Surgery, Kepler University Hospital, Krankenhausstr. 9, 4021 Linz, Austria. 8. Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Benekestrasse 2-8, 61231 Bad Nauheim, Germany. 9. Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany. 10. Department of Cardiology, Heart Center, University of Cologne, Medizinische Klinik III, Kerpener Str. 3, 50937 Cologne, Germany. 11. Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. 12. Department of Cardiac Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. 13. Department of Cardiology, Générale de Santé, Institut Cardiovasculaire Paris-Sud - Hôpital Privé Jacques Cartier, 6 Avenue du Noyer Lambert, 91300 Massy, France. 14. Department of Cardiovascular Surgery, German Heart Center, Technical University Munich, Lazarettstr. 36, 80636 Munich, Germany. 15. Medicare Center and Department for Percutaneous Treatment of Structural Heart Disease, Albertinen Heart Center, Wördemannsweg 25-27, 22527 Hamburg, Germany. 16. Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University Munich and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany. 17. Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistr. 52, 20246 Hamburg, Germany. 18. Department of Cardiology, Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus Essen, Klara-Kopp-Weg 1, 45134 Essen, Germany. 19. Department of Cardiology, University of Oulu and Heart Center, University of Turku, Hämeentie 11 P.O. Box 52, 20521 Turku, Finland. 20. Department of Cardiology, Paracelsus Medical University Nuernberg, General Hospital Nuernberg, Medizinische Klinik 8, Breslauer Str. 201, 90471 Nürnberg, Germany. 21. Cardiology Department. Interventional Cardiology Unit. University Hospital of Angers, 4 rue Larry, 49000 Angers, France. 22. Department of Cardiology, Toulouse Rangueil Hospital, Toulouse University School of Medicine, 1, Professeur Jean Poulhes Avenue, 31059 Toulouse, France. 23. Groupe Cardio-Vasculaire Interventionnel Clinique Pasteur, 45 avenue de Lombez BP 27617, 31076 Toulouse, France. 24. Department of Cardiology, Kuopio University Hospital Heart Center, PL 100, 70029 KYS Kuopio, Finland. 25. UO Cardiochirurgia Ospedale del Cuore G. Pasquinucci Fondazione Toscana Gabriele Monasterio, Via Aurelia Sud, 54100 Mass, Italy. 26. Department of Cardiology, Leeds Teaching Hospitals, LS23 6AL Leeds, UK. 27. Interventional Cardiology Unit, San Raffaele Hospital, Olgettina Street 60, 20132 Milan, Italy. 28. Department of Cardiology, West German Heart and Vascular Center, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany. 29. Ist Department of Cardiovascular Surgery, American Heart of Poland Inc., Armii Krajowej 101 Street, 43-316 Bielsko-Biala, Poland. 30. Valvular Heart Disease Department, National Institute of Cardiology, Alpejske 42, 06-628 Warsaw, Poland. 31. Cardiology Department, Rabin Medical Center and the "Sackler" Faculty of Medicine, Tel-Aviv University, Jabotinski St. 29, 39100 Petah-Tikva, Israel. 32. Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, Azienda Ospedaliera-University of Padova, 2 Via Nicolò Giustiniani, 35128 Padova, Italy. 33. Department of Cardiology, Klinikum Klagenfurt, Sankt Veiter Straße 47, Klagenfurt am Wörthersee, Austria. 34. The Heart Center, Department of Cardiology Rigshospitalet University of Copenhagen, Blegdamsvej 9, 2200 Copenhagen, Denmark. 35. Department of Cardiology, Galway University Hospitals, Newcastle Road, Galway, Ireland. 36. Department of Internal Medicine Division of Cardiology Duke University Medical Center and Duke Clinical Research Institute, 2400 Pratt Street Durham NC 27715, Durham, NC, USA.
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 (<72 h) of TF-TAVI patients requiring ECS was 34.6%. Overall in-hospital mortality was 46.0%, and highest in case of annular rupture (62%). Independent predictors of in-hospital mortality following ECS were age > 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 on behalf of the European Society of Cardiology. All rights reserved.
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 (<72 h) of TF-TAVI patients requiring ECS was 34.6%. Overall in-hospital mortality was 46.0%, and highest in case of annular rupture (62%). Independent predictors of in-hospital mortality following ECS were age > 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 on behalf of the European Society of Cardiology. All rights reserved.
Authors: Harun Kundi; Jeffrey J Popma; Kamal R Khabbaz; Louis M Chu; Jordan B Strom; Linda R Valsdottir; Changyu Shen; Robert W Yeh Journal: JAMA Cardiol Date: 2019-01-01 Impact factor: 14.676
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