Related Experiment Video
Updated: Jan 16, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Conditional 1-year outcomes after emergent conversion to open heart surgery during transcatheter aortic valve
Giuseppe Nasso1, Walter Vignaroli2, Gaetano Contegiacomo1
1Department of Cardiac Surgery, Anthea Hospital and Santa Maria Hospital GVM Care & Research, Bari, Italy.
Background:
Emergent conversion to open heart surgery (E-OHS) during transcatheter aortic valve implantation (TAVI) is rare (0.5%-2%) but carries high perioperative mortality. Long-term outcomes in survivors beyond 30 days are not well defined.
Objectives:
To assess 1-year conditional outcomes in patients who survived ≥30 days post-TAVI, comparing E-OHS survivors with propensity-matched uncomplicated TAVI recipients.
Methods:
Between January 2020 and August 2023, 825 consecutive TAVI procedures were performed at three Italian centers; 11 patients (1.3%) required E-OHS for catastrophic intraprocedural complications. A 30-day landmark analysis excluded early deaths (E-OHS: n = 3; controls: n = 25). Propensity matching (1:10) was performed on nine variables, yielding 8 E-OHS survivors and 80 well-matched controls.
Primary Endpoint:
All-cause mortality from day 31 to 1 year.
Secondary Endpoints:
Composite of death, moderate-or-greater paravalvular regurgitation, or valve reintervention; heart failure rehospitalization; permanent pacemaker; stroke/transient ischemic attack (TIA); and acute kidney injury (AKI).
Results:
Baseline characteristics were comparable. The mean age was 77 ± 5 years; EuroSCORE II was 6.8 ± 2.1%. One-year conditional mortality was 0% in E-OHS survivors vs. 2.9% in controls (p = 0.64). The composite endpoint occurred in 12.5% vs. 13.6% (p = 0.88). Other outcomes were similar: heart failure rehospitalization (12.5% vs. 11.2%), pacemaker implantation (12.5% vs. 9.6%), stroke/TIA (0% vs. 1.2%), and AKI (0% vs. 7.2%). No structural valve deterioration or thrombosis was observed.
Conclusions:
E-OHS survivors who overcome the initial high-risk phase achieve 1-year outcomes comparable to standard TAVI patients. These findings support immediate surgical backup within TAVI programs and provide reassurance for high-risk patient counseling.
