On site cardiac surgery for structural heart interventions: a fence to mend?

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Device Technology

Background:

• Transcatheter interventions like TAVI, TEER, and LAAO are increasingly vital for structural heart disease.
• Current guidelines mandate on-site cardiac surgery for TAVI, but not for TEER or LAAO.
• Increasing patient numbers lead to long waiting times, impacting mortality and morbidity.

Purpose of the Study:

• To evaluate the feasibility and safety of TAVI in centers without institutional on-site cardiac surgery (iOSCS).
• To address the debate surrounding the necessity of iOSCS for TAVI procedures.
• To explore the role of iOSCS for TAVI and other transcatheter interventions.

Main Methods:

• Analysis of data from randomized controlled trials and registries.
• Comparison of outcomes and conversion rates in centers with and without iOSCS.
• Examination of the relationship between TAVI complications, learning curve, and center volume.

Main Results:

• No significant differences in outcomes or emergent surgical bailout rates were found between centers with and without iOSCS.
• TAVI complication rates are directly related to the operator's learning curve and center volume.
• Evidence suggests TAVI can be safely performed in centers without iOSCS under specific conditions.

Conclusions:

• The requirement for iOSCS for TAVI may need re-evaluation.
• Focus should shift to operator experience and center volume as primary safety indicators for TAVI.
• Further exploration of decentralized TAVI models is warranted to reduce waiting times and improve patient access.