Safety of transcatheter aortic valve implantation in a hospital with visiting on-site cardiac surgery

Sameer Gafoor, Margarita Sirotina, Mirko Doss, Jennifer Franke, Kerstin Piayda, Simon Lam, Stefan Bertog, Laura Vaskelyte, Ilona Hofmann, Horst Sievert

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Abstract

Objectives: To describe the feasibility and safety of transcatheter aortic valve implantation (TAVI) with a visiting on-site cardiac surgery program for surgical back-up. Background: Both European and American guidelines recommend institutional cardiac surgery back-up for TAVI. However, the conversion to cardiac surgery is very rare, many complications of TAVI can be managed by catheter techniques and a visiting team can also provide surgical stand-by. Therefore, the need for institutional cardiac surgery (by a surgeon who routinely performs conventional surgical valve replacement at the institution performing TAVI) has been questioned. Methods: A retrospective review of consecutive TAVI cases with visiting on-site cardiac surgery was performed. Key demographic, echocardiographic, and procedural data were collected prospectively. Results: A total of 97 patients (81.9 ± 6.3 years) with high-risk criteria (log Euroscore 21.6 ± 14.4, chronic renal failure 39.2%, severe systolic dysfunction 24.7%) underwent TAVI with visiting on-site cardiac surgery at our institution. Local anesthesia with or without conscious sedation was used in 94.8% of patients. Procedural technical success was 100%, with 2 episodes of tamponade (both treated with pericardiocentesis) and a 16.5% vascular complication rate (all treated conservatively or percutaneously). Thirty-day mortality was 3.1%, with 5.2% rate of stroke and 8.2% rate of major bleeding. There were no conversions to surgery. Conclusions: TAVI can be done safely in the setting of a hospital with visiting on-site cardiac surgery. This requires careful patient selection, experienced operators and surgeons in experienced centers with well-established criteria and processes of care. In this setting, it may be an option for hospitals without institutional cardiac surgery.

Original languageEnglish (US)
Pages (from-to)76-81
Number of pages6
JournalJournal of Interventional Cardiology
Volume28
Issue number1
DOIs
StatePublished - Feb 1 2015

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    Gafoor, S., Sirotina, M., Doss, M., Franke, J., Piayda, K., Lam, S., Bertog, S., Vaskelyte, L., Hofmann, I., & Sievert, H. (2015). Safety of transcatheter aortic valve implantation in a hospital with visiting on-site cardiac surgery. Journal of Interventional Cardiology, 28(1), 76-81. https://doi.org/10.1111/joic.12176