Incidence and outcomes of emergent cardiac surgery during transfemoral transcatheter aortic valve implantation (TAVI): insights from the European Registry on Emergent Cardiac Surgery during TAVI (EuRECS-TAVI)

Abstract

Between 2014 and 2016, the need for ECS remained stable around 0.7%. Left ventricular guidewire perforation and annular rupture were the most frequent causes, accounting for almost half of ECS cases. Half of the patients could be salvaged by ECS-nevertheless, 1 year of all-cause mortality was high even in those ECS patients surviving the in-hospital period.

Revisiting the prevalence and diversity of localized thinning of the left ventricular apex

“…Notwithstanding the commonness of this fragile anatomy and greater frequency of left heart catheterizations, left ventricular apical perforation seems surprisingly uncommon in contrast to the perforation of the apex of the right ventricle 1 . However, complications have occurred, 6‐8 along with a growing increase in the procedures related to the left ventricle.…”

“…Although the absolute value of the left ventricular apical thin area was smaller in this population, the potential risk of apical perforation should not be underestimated when inserting any wires or catheters into the left ventricle (Figure 3). The presence of a stiff guidewire in the apex of the left ventricle is a known risk factor for left ventricular perforation, 8 and left ventricular guidewire perforation was the leading cause (28.3%) of life‐threatening complications requiring emergent cardiac surgery during transfemoral transcatheter aortic valve implantation, which was reported in 0.76% of the 27 760 procedures 7 …”

“…The left ventricular apex normally has a paper‐thin structure (Figure 1). 1‐5 This anatomy carries a potential life‐threatening risk during any interventional approaches within the left ventricle, and such treatment may lead to a catastrophic consequence 6‐8 . However, available data regarding this structural anatomy are limited to variable samples, methodologies, and results 2–5,9‐11 .…”

Valvuloplasty balloon entrapment in a self‐expanding aortic valve stent frame after inadvertent wire passage through the outflow struts

“…If a complication like balloon entrapment during TAVR occurs, the management strategy should carefully be re‐evaluated and discussed in an interdisciplinary team to adequately assess the potential benefit‐risk ratio for the patient at all time points. In case of percutaneous retrieval failure, urgent cardiac surgery can be an option to retrieve the balloon, although conversion to open heart surgery after TAVR is associated with a significantly increased in‐hospital mortality of over 50% . Therefore, a primary percutaneous management approach seems to be favorable.…”

Sealing capacity of the ventricular muscle band after iatrogenic left ventricular perforation during transcatheter aortic valve implantation

“…Left ventricular (LV) perforation is a seldom (0.15%1) but feared complication during transcatheter aortic valve implantation (TAVI) and usually requires emergent surgical repair 2. Handling of this rare but possible life-threatening event requires well-considered action by the implanting team and is associated with substantially increased intrahospital mortality and impaired outcome.…”