Städtisches Klinikum München GmbH, Klinikum Neuperlach, Department of Cardiology, Munich, Germany.
EuroIntervention. 2013 Aug 22;9(4):446-51. doi: 10.4244/EIJV9I4A73.
To evaluate: 1) the causes of emergency conversion from transcatheter aortic valve implantation (TAVI) to surgery, 2) procedural settings, and 3) short-term outcome of converted patients.
The prospective German TAVI registry was used to identify patients who underwent bail-out surgery during TAVI. Additionally, standardised questionnaires were developed and used to assess more detailed periprocedural and postprocedural data. Emergency conversion from TAVI to open cardiac surgery was required in 24 of 1,975 patients (1.2%). Primary conversion causes were aorto-valvular complications (i.e., aortic annulus rupture, aortic perforation, or thoracic aortic dissection). This was followed by prosthesis embolisation, myocardial perforation, severe aortic regurgitation, and coronary obstructions. The mean time interval between abortions of TAVI to surgery was 19 minutes (SD ± 17 min, range 5-80 min). Four of 24 patients (16.7%) died during the initial surgery, seven of 24 (29.2%) within the first 72 hours and the 30-day mortality was 45.8%. The highest mortality was observed in patients with aortic perforation or dissection (4/5, 80%). Mortality rates for other entities were: prosthesis embolisation 40% (2/5), myocardial perforation 50% (2/4), annulus rupture 67% (2/3), severe aortic regurgitation 33% (1/3), and coronary impairment 0% (0/3).
Emergency conversion from TAVI to surgery is a rare event carrying a mortality of around 45% after 30 days. Outcome of converted patients with prior injury of aortic, aorto-valvular, or myocardial tissue during TAVI was poor, whereas patients with severe aortic regurgitation and those with coronary complications had a more favourable outcome after 30 days. Collected procedural and outcome data demand on-site cardiac surgery as a prerequisite for TAVI and constant process optimisation efforts regarding such emergency scenarios.
评估：1）经导管主动脉瓣植入术（TAVI）转为手术的原因，2）手术过程设置，以及 3）转为手术患者的短期预后。
使用前瞻性德国 TAVI 注册研究来识别 TAVI 过程中需要紧急转为心脏手术的患者。此外，还制定了标准化问卷并用于评估更详细的围手术期和术后数据。在 1975 名患者中，有 24 名（1.2%）需要紧急转为开胸心脏手术。主要转为手术的原因是主动脉瓣相关并发症（即主动脉瓣环破裂、主动脉穿孔或胸主动脉夹层）。其次是假体栓塞、心肌穿孔、严重主动脉瓣反流和冠状动脉阻塞。TAVI 转为手术的平均时间间隔为 19 分钟（标准差±17 分钟，范围 5-80 分钟）。24 名患者中有 4 名（16.7%）在初始手术中死亡，24 名中有 7 名（29.2%）在最初 72 小时内死亡，30 天死亡率为 45.8%。主动脉穿孔或夹层患者的死亡率最高（4/5，80%）。其他实体的死亡率为：假体栓塞 40%（2/5），心肌穿孔 50%（2/4），瓣环破裂 67%（2/3），严重主动脉瓣反流 33%（1/3），冠状动脉损伤 0%（0/3）。
TAVI 转为手术是一种罕见事件，30 天后的死亡率约为 45%。在 TAVI 过程中先前有主动脉、主动脉瓣或心肌组织损伤的转为手术患者的预后较差，而有严重主动脉瓣反流和冠状动脉并发症的患者在 30 天后的预后较好。收集的手术过程和结果数据需要现场心脏手术作为 TAVI 的前提条件，并不断优化此类紧急情况的处理流程。
