Original Title: Emergent cardiac surgery during transcatheter aortic valve implantation (TAVI): insight the Edwards SAPIENS Aortic Bioprosthesis Outcome (SOURCE) registry. Reference: Holger Eggerbrecht, et al. EuroIntervention 2014;10:975-81

SOURCE register data from patients receiving transcatheter aortic valve implantation with the Edwards Sapiens valve, were analyzed; out of 2307 patients, 27 (1.2%) required emergency cardiac surgery (ECS).

Valve stenosis was equally severe, but the aortic annulus diameter was larger in those that required ECS; this difference increased when using a

ECS causes were embolism/migration in 9 patients, aortic injury (dissection and perforation) in 7, aortic annulus rupture in 3, severe aortic regurgitation in 3, myocardial tamponade in 2, transapical bleeding in 1, heart block in 1 and suboptimal valve deployment in 1. 10 ECS patients died within 72 hours (VARC-2). At 30 days, mortality was 51.9% vs. 7.8% of those that did not require ECS (p<0.001). At 90 days, mortality was even higher, reaching 70% (19/27).

Conclusion

ECS rates in the context of TAVI is very low (1.2%), it should be performed with no delay and is associated with a 52% mortality rate at 30 days. Severe complications with acute evolution (annulus rupture or aortic injury) presented even higher mortality rates.

Commentary

This study, as well as others, has shown that although ECS during TAVI is not a frequent procedure, it unfortunately has high mortality rates within 90 days. This depends on the type of complications it may cause, and calls for a technological effort to develop more flexible and better adjusted valves to avoid these complications. 

Courtesy of Dr. Carlos Fava
Interventional Cardiologist
Favaloro Foundation – Buenos Aires

Carlos Fava