Emergent cardiac surgery during transcatheter aortic valve implantation (TAVI): a weighted meta-analysis of 9,251 patients from 46 studies

Abstract

Reported rates of ECS during TAVI were low with embolisation or dislocation of the prosthesis being the most common cause. ECS was associated with grave prognosis with two out of three patients dying by 30 days. Thus, refinement in TAVI technology should not only focus on miniaturisation and improving flexibility of the delivery systems and/or devices -which may have the potential for decreasing aortic dissection, annular rupture, and tamponade- but also incorporate modifications to prevent embolisation/dislocation of the valve.

An emergent surgery for valve migration in transcatheter aortic valve replacement

“…[2] Migration to the left ventricle inevitably require ECS. [3] Although percutaneousbail-out maneuvers (i.e., transcatheter valve-invalve implantation) are advised for supra-annular migration in high-risk or inoperable patients, this option remains questionable in those with a low surgical risk.…”

“…Severe peri-procedural TAVR complications such as paravalvular leakage, aortic and/ or ventricular bleeding, tamponade, and malpositioning/ migration of valve have been reported in up to 7.7% of the procedures. [2] One-percent of these complications requires an emergent cardiac surgery (ECS) with a nine-fold higher mortality rate. [2] It is recommended that all potential TAVR patients should be assessed by the Heart Team to discuss the possible risks and benefits of each option and to inform the patient clearly and to identify beforehand the outlook of Heart Team in case of major peri-procedural complications.…”

“…[2] One-percent of these complications requires an emergent cardiac surgery (ECS) with a nine-fold higher mortality rate. [2] It is recommended that all potential TAVR patients should be assessed by the Heart Team to discuss the possible risks and benefits of each option and to inform the patient clearly and to identify beforehand the outlook of Heart Team in case of major peri-procedural complications. Herein, we report a successful surgical management of valve migration during TAVR in a low-risk patient with bicuspid aortic valve (BAV).…”

Salvaging catastrophe in transcatheter aortic valve implantation: rehearsal, preassigned roles, and emergency preparedness

“…1,5 The 30-day mortality for these patients was 67%-ninefold higher than for uneventful TAVI procedures. 1 Nevertheless, the mortality in one institution was found to be 35%-almost 50% lower than the incidence described in the meta-analysis-by utilizing a heart-team approach along with preparation of both the patient and the hybrid OR for emergency open heart surgery in every TAVI case. 6 In this single-centre study of 411 patients undergoing TAVI via the transfemoral or the Salvaging catastrophe in TAVI 919 transapical route, 20 (4.9%) patients required ECS during their TAVI procedure.…”

“…1 In a recent meta-analysis, catastrophic intraoperative complications during TAVI requiring emergency cardiac surgery (ECS) were reported to occur in 1.0-7.7% of cases and were associated with 67% mortality. 1 Emergency rescue plans commonly include cardiopulmonary resuscitation (CPR), femoro-femoral cardiopulmonary bypass (CPB), and attempts at hemodynamic stabilization before definitive intervention can be achieved. Nevertheless, most cases of emergent resuscitation remain chaotic and disorganized and often take longer than necessary, even in experienced centres.…”