Short-term results of transcatheter aortic valve replacement converted to surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LU Qilin ¹ , ZHANG Jieqiong ² , AN Jinghui ² , LIU Su ² , MA Qianli ² ,  SHI Fengwu ²

1. Graduate School, Hebei Medical University, Shijiazhuang 050011, P. R. China;
2. Department of Cardiovascular Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050004, P. R. China;

Corresponding author：

SHI Fengwu, Email: shifengwu65@163.com

Keywords：

Transcatheter aortic valve replacement; surgery; result analysis

DOI：

10.7507/1007-4848.202306033

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To analyze the recent clinical results of emergency conversion of transcatheter aortic valve replacement (TAVR) to surgery, and summarize the clinical experience. Methods The clinical data of patients who underwent TAVR emergency conversion surgery in the Department of Cardiovascular Surgery of the Second Hospital of Hebei Medical University from 2018 to 2023 were collected, and the results of 1-month follow-up after surgery were recorded. Results Totally 253 patients underwent TAVR, and 11 patients underwent emergency conversion to surgery, with an emergency conversion rate of 4.3%. Among the 11 patients, 7 were males and 4 were females, with an average age of 69.55±5.01 years. The causes of urgent conversion to surgery in TAVR were valve stent displacement (63.6%), left ventricular perforation and rupture (18.2%), and a large amount of perivalvular reflux (18.2%) after the insertion of the second valve. One patient died intraoperative, with a perioperative mortality rate of 9.1%. Among the 10 surviving patients, 8 had pulmonary infection, 7 severe pneumonia, 3 pleural effusion, 8 liver function injury, 3 renal function injury, 5 upper gastrointestinal bleeding, 1 cerebrovascular complications, 1 atrial fibrillation, 1 ventricular premature contraction, 1 atrioventricular block, and 3 complete left bundle branch block. After one month of postoperative follow-up, one patient died. The 30-day mortality rate after TAVR emergency conversion surgery was 18.2%, and the quality of life of 9 patients (81.8%) improved significantly compared to before surgery. There were no readmission patients with cardiovascular system diseases. Conclusion The incidence of emergency conversion to surgery in TAVR is low, but the incidence of surgical complications is high, and the 30-day postoperative mortality rate is also high. When severe complications occur during TAVR surgery, emergency conversion to surgical surgery can still bring good early clinical results for most patients.

1.	Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: First human case description. Circulation, 2002, 106(24): 3006-3008.
2.	Bowdish ME, D'Agostino RS, Thourani VH, et al. STS adult cardiac surgery database: 2021 update on outcomes, quality, and research. Ann Thorac Surg, 2021, 111(6): 1770-1780.
3.	刘鹏, 鲍贤豪, 马孝琛, 等. 经导管主动脉瓣置换术术后并发症及其治疗进展. 血管与腔内血管外科杂志, 2022, 8(9): 1093-1098.
4.	Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
5.	Griese DP, Reents W, Kerber S, et al. Emergency cardiac surgery during transfemoral and transapical transcatheter aortic valve implantation: Incidence, reasons, management, and outcome of 411 patients from a single center. Catheter Cardiovasc Interv, 2013, 82(5): E726-E733.
6.	Lange R, Bleiziffer S, Piazza N, et al. Incidence and treatment of procedural cardiovascular complications associated with trans-arterial and trans-apical interventional aortic valve implantation in 412 consecutive patients. Eur J Cardiothorac Surg, 2011, 40(5): 1105-1113.
7.	Seiffert M, Conradi L, Baldus S, et al. Severe intraprocedural complications after transcatheter aortic valve implantation: Calling for a heart team approach. Eur J Cardiothorac Surg, 2013, 44(3): 478-484.
8.	Eggebrecht H, Schmermund A, Kahlert P, et al. Emergent cardiac surgery during transcatheter aortic valve implantation (TAVI): A weighted meta-analysis of 9, 251 patients from 46 studies. EuroIntervention, 2013, 8(9): 1072-1080.
9.	Nielsen NE, Baranowska J, Bramlage P, et al. Minimizing the risk for left ventricular rupture during transcatheter aortic valve implantation by reducing the presence of stiff guidewires in the ventricle. Interact Cardiovasc Thorac Surg, 2019, 29(3): 365-370.
10.	Li F, Wang X, Wang Y, et al. Short- and long-term outcome after emergent cardiac surgery during transcatheter aortic valve implantation. Ann Thorac Cardiovasc Surg, 2021, 27(2): 112-118.
11.	Zahn R, Gerckens U, Grube E, et al. Transcatheter aortic valve implantation: First results from a multi-centre real-world registry. Eur Heart J, 2011, 32(2): 198-204.

1. Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: First human case description. Circulation, 2002, 106(24): 3006-3008.
2. Bowdish ME, D'Agostino RS, Thourani VH, et al. STS adult cardiac surgery database: 2021 update on outcomes, quality, and research. Ann Thorac Surg, 2021, 111(6): 1770-1780.
3. 刘鹏, 鲍贤豪, 马孝琛, 等. 经导管主动脉瓣置换术术后并发症及其治疗进展. 血管与腔内血管外科杂志, 2022, 8(9): 1093-1098.
4. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
5. Griese DP, Reents W, Kerber S, et al. Emergency cardiac surgery during transfemoral and transapical transcatheter aortic valve implantation: Incidence, reasons, management, and outcome of 411 patients from a single center. Catheter Cardiovasc Interv, 2013, 82(5): E726-E733.
6. Lange R, Bleiziffer S, Piazza N, et al. Incidence and treatment of procedural cardiovascular complications associated with trans-arterial and trans-apical interventional aortic valve implantation in 412 consecutive patients. Eur J Cardiothorac Surg, 2011, 40(5): 1105-1113.
7. Seiffert M, Conradi L, Baldus S, et al. Severe intraprocedural complications after transcatheter aortic valve implantation: Calling for a heart team approach. Eur J Cardiothorac Surg, 2013, 44(3): 478-484.
8. Eggebrecht H, Schmermund A, Kahlert P, et al. Emergent cardiac surgery during transcatheter aortic valve implantation (TAVI): A weighted meta-analysis of 9, 251 patients from 46 studies. EuroIntervention, 2013, 8(9): 1072-1080.
9. Nielsen NE, Baranowska J, Bramlage P, et al. Minimizing the risk for left ventricular rupture during transcatheter aortic valve implantation by reducing the presence of stiff guidewires in the ventricle. Interact Cardiovasc Thorac Surg, 2019, 29(3): 365-370.
10. Li F, Wang X, Wang Y, et al. Short- and long-term outcome after emergent cardiac surgery during transcatheter aortic valve implantation. Ann Thorac Cardiovasc Surg, 2021, 27(2): 112-118.
11. Zahn R, Gerckens U, Grube E, et al. Transcatheter aortic valve implantation: First results from a multi-centre real-world registry. Eur Heart J, 2011, 32(2): 198-204.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesShort-term results of transcatheter aortic valve replacement converted to surgery

Abstract Full text Figures/Tables Video References Cited by

Format

Content