The role of the heart team in complicated transcatheter aortic valve implantation: a 7-year single-centre experience

Selected in European Journal of Cardio-Thoracic Surgery by Rylski

References

Authors

Philipp Kiefer, Jörg Seeburger, Thilo Noack, Thomas Schröter, Axel Linke, Gerhard Schuler, Martin Haensig, Marcel Vollroth, Friedrich-Wilhelm Mohr and David Michael Holzhey

Reference

Eur J Cardiothorac Surg. 2015 Jun;47(6):1090-6.

Published

June 2015

Link

Access the abstract

My Comment

Background

The current European guidelines recommend performing transcatheter aortic valve implantation (TAVI) in the heart team. However, there is a strong drive to perform TAVI in interventional units without surgical support. The authors aimed to provide insight into the complications during and after TAVI to clarify the necessity of on-site cardiac surgery.

Results

  • A 7-year single-centre experience
  • A total of 2,287 (1,523 transfemoral, 752 transapical, 12 transaortic) TAVI patients
  • Mean age 85 ± 5 years, mean log EuroSCORE 22 ± 16, 84% female
  • 245 (11%) patients required surgical intervention due to major complications: 42 (25 transfemoral, 17 transapical) patients were converted to full sternotomy and 27 required short-term use of the heart-lung machine, 85 patients underwent vascular surgical treatment, 54 patients had rethoracotomy within initial stay and 15 required a cardiac reoperation
  • Conversion to sternotomy was due to malposition of the valve, left ventricular perforation, occlusion of the coronaries, rupture of the annulus, type A aortic dissection and left main coronary artery dissection

My comments

From this data and other reports it can be concluded that 1 of 100-200 TAVI patients requires immediate surgical intervention for major TAVI procedure specific complications. There is no doubt, that an experienced 24h, on-site cardiac surgical service is absolutely necessary for these patients. As long as we do experience the complications, the working heart team, as is proposed in the guidelines, is absolutely necessary for the preoperative planning and in particular for each TAVI procedure to ensure optimal safety for the patients.

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