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

Abstract

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.

Keywords: aortic valve; aortic valve intervention; emergency conversions; Open surgery after TAVI; reoperation after TAVI; subsequent cardiac surgery; transcatheter aortic valve implantation.