Cardiac surgery following transcatheter aortic valve replacement

Saha, Shekhar; Peterß, Sven; Mueller, Christoph; Deseive, Simon; Sadoni, Sebastian; Hausleiter, Jörg; Maßberg, Steffen; Hagl, Christian; Jóskowiak, Dominik

doi:10.1093/ejcts/ezab217

Cited by 7 publications

(3 citation statements)

References 27 publications

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“…Infective endocarditis has been reported to be the most common indication of surgery following aortic THV implantation [50]. Following THV implantation, vigilance, early diagnosis, adequate antibiotic treatment, and early surgery are essential [50,51] in cases of infective endocarditis.…”

Section: Operative Considerationsmentioning

confidence: 99%

Hybrid Surgery for Severe Mitral Valve Calcification: Limitations and Caveats for an Open Transcatheter Approach

et al. 2022

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Background and Objectives: Mitral stenosis with extensive mitral annular calcification (MAC) remains surgically challenging in respect to clinical outcome. Prolonged surgery time with imminent ventricular rupture and systolic anterior motion can be considered as a complex of causal factors. The aim of our alternative hybrid approach was to reduce the risk of annual rupture and paravalvular leaks and to avoid obstruction of the outflow tract. A review of the current literature was also carried out. Materials and Methods: Six female patients (mean age 76 ± 9 years) with severe mitral valve stenosis and severely calcified annulus underwent an open implantation of an Edwards Sapien 3 prosthesis on cardiopulmonary bypass. Our hybrid approach involved resection of the anterior mitral leaflet, placement of anchor sutures and the deployment of a balloon expanded prosthesis under visual control. Concomitant procedures were carried out in three patients. Results: The mean duration of cross-clamping was 95 ± 31 min and cardiopulmonary bypass was 137 ± 60 min. The perioperative TEE showed in three patients an inconspicuous, heart valve-typical gradient on all implanted prostheses and a clinically irrelevant paravalvular leakage occurred in the anterior annulus. In the left ventricular outflow tract, mild to moderately elevated gradients were recorded. No adverse cerebrovascular events and pacemaker implantations were observed. All but one patient survived to discharge. Survival at one year was 83.3%. Conclusions: This “off label” implantation of the Edwards Sapien 3 prosthesis may be considered as a suitable bail-out approach for patients at high-risk for mitral valve surgery or deemed inoperable due to extensive MAC.

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Section: Operative Considerationsmentioning

confidence: 99%

Hybrid Surgery for Severe Mitral Valve Calcification: Limitations and Caveats for an Open Transcatheter Approach

et al. 2022

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“…However, previous studies have shown that TAVR prostheses can be explanted with reasonable results and no damage to adjacent structures [ 6 , 17 ]. The superior outcomes in our study may be related to the management of our patients in a high-volume heart valve center with a multidisciplinary endocarditis team approach [ 22 ].…”

Section: Commentmentioning

confidence: 99%

“…Although current guidelines consider surgery to be the best option in cases of prosthetic valve endocarditis (PVE), the current literature reports a general reluctance toward the surgical treatment of IE following transcatheter aortic valve implantation (TIE), with some patients entering palliative care upon diagnosis [ 1 , 2 , 3 , 4 , 5 ]. Infective endocarditis (IE) is the leading cause of reoperation following transcatheter aortic valve replacement [ 6 ]. Up to 90% of patients suffering from TIE undergo conservative treatment, and this has been associated with high in-hospital mortality and poor short-term survival [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Surgery for Aortic Prosthetic Valve Endocarditis in the Transcatheter Era

Saha

Ali

Schnackenburg

et al. 2022

JCM

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Objectives: As surgical experience with infective endocarditis following transcatheter aortic valve replacement is scarce, this study compared the perioperative and short-term outcomes of patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement. Methods: Between January 2013 and December 2020, 468 consecutive patients were admitted to our center for surgery for IE. Among them, 98 were operated on for endocarditis following surgical aortic valve replacement and 22 for endocarditis following transcatheter aortic valve replacement. Results: The median EuroSCORE II (52.1 (40.6–62.0) v/s 45.4 (32.6–58.1), p = 0.207) and STS-PROM (1.8 (1.6–2.1) v/s 1.9 (1.4–2.2), p = 0.622) were comparable. Endocarditis following transcatheter aortic valve replacement accounted for 13.7% of the aortic prosthetic valve endocarditis between 2013 and 2015; this increased to 26.9% in the years 2019 and 2020. Concomitant procedures were performed in 35 patients (29.2%). The operative mortality was 26.5% in the endocarditis following surgical aortic valve replacement group and 9.1% in the endocarditis following transcatheter aortic valve replacement group (p = 0.098). Upon follow-up, survival at 6 months was found to be 98% in the group with endocarditis following surgical aortic valve replacement and 89% in the group with endocarditis following transcatheter aortic valve replacement (p = 0.081). Conclusions: Patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement present with comparable risk profiles and can be surgically treated with comparable results. Surgery as a curative option should not be rejected even in this intermediate-risk cohort.

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