Can TAVI be performed without on-site cardiac surgery?

Aim of this analysis in to assess the prevalence and post-procedural outcomes of surgical bailout during transcatheter aortic valve implantation (TAVI).

Patients undergoing TAVI from September 2017 to March 2023 were enrolled from two high volume centers. All the procedures were performed with on-site cardiac surgery, but especially the scrubbed cardiac surgeon. The primary endpoint was in-hospital mortality of TAVI patients after emergent cardiac surgery (ECS). Secondary endpoints were intra-operative and 1-year mortality, and post-procedural complications such as acute kidney injury (AKI), stroke, myocardial infarction (MI), conduction abnormalities, need for inotropic support and intensive care unit (ICU) and in- hospital length of stay.

A total of 1347 consecutive patients underwent transfemoral TAVI. Ten patients (0.74 %), representing the study population, reported intra-procedural complications requiring ECS: seven patients received a self-expandable prosthesis; three patients received a balloon expandable prosthesis. Indications for ECS included: type A dissection (n = 2), aortic annulus rupture (n = 1), left(n = 1) and right (n = 2) ventricle perforation, mitral valve apparatus damage (n = 2), prosthesis embolization (n = 2). Four patients required post-operative inotropic support. One case of minor stroke and one case of AKI (grade III) were reported. Three patients developed a post procedural left bundle branch block (LBBB). Median ICU and hospital length-of-stay were 4.5 (2-7.75) days and 14 (8-22) days, respectively. One case of in-hospital mortality was reported.

The on-site cardiac surgery, with the scrubbed heart surgeon, represents a life-saving resource for TAVI centers in case of ECS, and it is essential to achieve low-rate in-hospital mortality.