Can TAVI be performed without on-site cardiac surgery?

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Background:

• Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure for aortic stenosis.
• Intra-procedural complications can necessitate emergent cardiac surgery (ECS).
• The role of on-site surgical teams in managing these complications is critical.

Purpose of the Study:

• To assess the prevalence of surgical bailout during TAVI.
• To evaluate post-procedural outcomes in patients requiring ECS after TAVI.
• To determine the impact of on-site cardiac surgery on TAVI outcomes.

Main Methods:

• A retrospective analysis of 1347 patients undergoing transfemoral TAVI between September 2017 and March 2023.
• Data collected from two high-volume centers with on-site cardiac surgery.
• Primary endpoint: in-hospital mortality after ECS. Secondary endpoints: intra-operative and 1-year mortality, and complications like AKI, stroke, MI, and LBBB.

Main Results:

• Ten patients (0.74%) required ECS due to complications including aortic dissection, annulus rupture, and ventricular perforation.
• Four patients needed post-operative inotropic support; one experienced stroke and one AKI (grade III).
• In-hospital mortality was low (one case), with median ICU and hospital stays of 4.5 and 14 days, respectively.

Conclusions:

• On-site cardiac surgery with a dedicated surgical team is a vital resource for TAVI centers.
• This setup is essential for managing emergent complications effectively.
• The presence of an on-site surgical team contributes to achieving low in-hospital mortality rates in TAVI patients requiring ECS.