Associazione Nazionale Medici Cardiologi Ospedalieri



Conversion to open surgery for complicated tavi: still futile?

Petrini Francesca Firenze (Firenze) – Aou Careggi | Paduvakis Iorgos Firenze (Firenze) – Aou Careggi | Cerillo Alfredo Giuseppe Firenze (Firenze) – Aou Careggi | Stefano Pier Luigi Firenze (Firenze) – Aou Careggi

Background and aim: mechanical complications of TAVI may be catastrophic, and conversion to open surgery in this context has been associated with an extremely poor prognosis, with a mortality close to 50%. We report our recent experience on 9 patients requiring cardiac surgery during TAVI.

Patients and methods: 9 patients undergoing various transcatheter procedures at a high volume centre required cardiac surgery for valve misplacement (2), valve embolization (2), annular rupture (3), acute coronary occlusion (1) and aortic dissection (1). Four patients were initially treated by a hybrid team including a cardiac surgeon performing transcatheter procedures (3 TAVI in NAVR and one transseptal Mitral VIV), while five were performed by an interventional cardiology team (all TAVI).

Results: The complications and the surgical procedures performed are reported in the table. Four patients underwent immediate conversion in the hybrid room, 3 underwent delayed conversion and two were managed conservatively. Eight patients survived and were discharged from the hospital. The only patient dying was a TAVI patient having aortic valve embolization. A second transcatheter valve was deployed too ventricular. The patient had cardiac arrest needing CRP and the surgical team was called to start ECMO assistance several minutes after the initial complication.

Comment: Our small series suggests that prompt conversion to open surgery, especially if performed immediately by surgeons that were initially involved in the transcatheter procedure, might offer excellent results. We believe that hybrid teams may offer a significant benefit, especially in low-risk patients and during complex or off-label procedures.