CAN TRANSCATHETER AORTIC VALVE IMPLANTATION BE PERFORMED WITHOUT ON-SITE CARDIAC SURGERY?

Introduction: despite lower invasivity, transcatheter aortic valve implantation (TAVI) carries a potential risk of feared intra-operative complications. Emergent cardiac surgery (ECS) should be considered a truly life-saving procedure in case of TAVI-related complications. The aim of the present analysis is to assess the prevalence and post-procedural outcomes of surgical bailout during TAVI. Methods: patients undergoing TAVI from September 2017 to March 2023 were enrolled from two high volume cardiac centers. All the procedures had an on-site cardiac surgeon. The primary endpoint was in-hospital mortality of TAVI patients after ECS. Secondary endpoints were intra-operative and 1-year mortality, and post-procedural complications such as acute kidney injury (AKI), stroke, myocardial infarction (MI), conduction abnormalities, need for inotropic support and intensive care unit (ICU)/hospital length of stay (LOS). Results: During the study period 1347 TAVI were planned. 10 patients (0,74%) reported intra- procedural complications requiring ECS. Indications for open cardiac surgery included: type A dissection (n=2), aortic annulus rupture (n=1), left ventricle perforation (n=1), right ventricle perforation (n=2), mitral valve apparatus damage (n=2), prosthesis embolization (n=2). 4 patients (40%) required post-operative inotropic support. 1 case of stroke (10%) and 1 case of AKI (10%) were reported. 3 patients (30%) developed LBBB. Median ICU and hospital length-of-stay were 4,5 (2-7,75) days and 14 (8-22) days, respectively. 1 case (10%) of in- hospital mortality was reported. 1 out of 9 discharged patients died during follow-up period. Conclusions: the on-site heart surgeon represents a life-saving resource for TAVI centers, and it is mandatory to achieve good post-procedural outcomes.