In a recent study, researchers explored predictors for and outcomes of open-heart surgery in patients after a transcatheter aortic valve implantation (TAVI). The study’s authors noted they also sought to evaluate the relatively rare cases of emergency open-heart surgery in TAVI follow-up due to progression of other cardiac pathologies.
Ultimately, the study suggested that patients who required emergency open-heart surgery due to TAVI-related complications or other cardiac conditions represented rare but urgent cases. The researchers added that, although early attrition was “substantial,” a relevant number of this population had acceptable clinical outcomes. Their findings were published in the Journal of Cardiac Surgery.
Emergency Cardiac Surgery After TAVI
The authors enrolled 27 patients (59.3% male) with a median age of 79 years (interquartile range [IQR], 76-84 years) who required open-heart surgery via cardiopulmonary bypass after receiving a TAVI. The median time from initial TAVI to emergency surgery was 3 months (IQR, 0-26 months).
According to the report, the major indicators for emergency open-heart surgery were endocarditis in 11 patients (40.7%); annular rupture, severe paravalvular leak, and severe stenosis in 3 patients each (11.1%); and severe tricuspid valve regurgitation, valve thrombosis, valve malposition, valve migration, ostial right coronary artery obstruction, left ventricular rupture, and type A aortic dissection in 1 patient each (3.7%).
Investigators noted 8 participants had emergent TAVI surgical conversions, and 3 patients required new permanent pacemaker implantation. Overall, immediate procedural mortality was 25.9%, any-procedural mortality was 40.7%, and all-cause mortality was 51.9%, with 11 of 12 deaths due to cardiovascular reasons. No strokes were reported.
“The option of subsequent surgical conversion remains an indispensable tool in the setting of a modern heart team-based approach,” the authors observed. “These results substantiate recommendations regarding both having a cardiac surgical service on-site and performing TAVI as an interdisciplinary team.”