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Incidence and outcomes of emergent cardiac surgery during transfemoral transcatheter aortic valve implantation (TAVI): Insights from the e uropean R egistry on e mergent C ardiac S urgery during TAVI (EuRECS-TAVI)

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DOI

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  • Holger Eggebrecht
  • Beatriz Vaquerizo
  • Cesar Moris
  • Eduardo Bossone
  • Johannes Lämmer
  • Martin Czerny
  • Andreas Zierer
  • Holger Schröfel
  • Won Keun Kim
  • Thomas Walther
  • Smita Scholtz
  • Tanja Rudolph
  • Christian Hengstenberg
  • Jörg Kempfert
  • Marco Spaziano
  • Thierry Lefevre
  • Sabine Bleiziffer
  • Joachim Schofer
  • Julinda Mehilli
  • Moritz Seiffert
  • Christoph Naber
  • Fausto Biancari
  • Dennis Eckner
  • Charles Cornet
  • Thibault Lhermusier
  • Raphael Philippart
  • Antti Siljander
  • Alfredo Giuseppe Cerillo
  • Daniel Blackman
  • Alaide Chieffo
  • Philipp Kahlert
  • Katarzyna Czerwinska-Jelonkiewicz
  • Piotr Szymanski
  • Uri Landes
  • Ran Kornowski
  • Augusto D'Onofrio
  • Carl Kaulfersch
  • Lars Søndergaard
  • Darren Mylotte
  • Rajendra H. Mehta
  • Ole De Backer
Vis graf over relationer

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.

OriginalsprogEngelsk
TidsskriftEuropean Heart Journal
Vol/bind39
Udgave nummer8
Sider (fra-til)676-684
ISSN0195-668X
DOI
StatusUdgivet - 2018

ID: 54976434