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

Kiefer et al. The role of the heart team in complicated transcatheter aortic valve implantation: a 7-year single-centre experience. Eur J Cardiothorac Surg. 2015 May 19;47(6):1090–6.

Objectives: European guidelines recommend to perform transcatheter aortic valve implantation (TAVI) within a multidisciplinary heart team. However, there is a strong drive—despite existing guidelines—to perform TAVI outside of specialized centres. The aim of this study was to clarify the necessity of on-site cardiac surgery by providing a clear insight into the complications during/after TAVI that needed surgical management.

Methods: A total of 2287 (1523 transfemoral, 752 transapical and 12 transaortic) patients, with a mean age of 84.5 ± 5.3 years, and a mean log EuroSCORE of 21.7 ± 16.3, of which 205 were female (84%), underwent TAVI since February 2006 at our institution. All procedure-related complications that required surgical interventions, whether immediate or delayed but within the initial hospital stay, were recorded and retrospectively analysed.

Results: Out of this cohort, 245 (10.7%) patients required surgical treatment due to major complications. A total of 42 patients (1.8%) underwent conversion to full sternotomy and 27 (1.2%) were dependent on the short-term use of the heart–lung machine. Vascular complications with surgical intervention were seen in 85 patients (3.7%), 54 patients (2.4%) had to have a rethoracotomy within their initial stay and 15 (0.7%) required a cardiac reoperation.

Conclusions: Severe complications during TAVI that can only be resolved surgically will continue to occur. Therefore, each TAVI procedure should be conducted or accompanied by a cardiac surgeon and an experienced team within a specialized centre.

About The Author

Structural Heart Disease Australia

Structural Heart Disease Australia is an incorporated association focused on education in valvular and structural cardiac diseases. It was started by group of echocardiographers, anaesthetists, clinical and interventional cardiologists, and cardiothoracic surgeons to provide a useful learning resource for medical professionals.

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