Department of Structural Heart Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Magnetic Resonance Imaging, Fuwai Hospital; Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ann Thorac Cardiovasc Surg. 2021 Apr 20;27(2):112-118. doi: 10.5761/atcs.oa.20-00123. Epub 2021 Jan 15.
Our study aimed to evaluate short- and long-term outcomes of patients who required emergent conversion from transcatheter aortic valve implantation (TAVI) to open surgery. Besides, the reasons and procedural settings of emergent cardiac surgery (ECS) were also reported.
We retrospectively reviewed the patients who underwent TAVI in our institution between 2012 and 2019 and collected the clinical data of cases who converted from TAVI to bail-out surgery. Telephone and outpatient follow-ups were performed.
Of 516 TAVI patients, 20 required ECS, and the bail-out surgery occurred less frequently with the increase in TAVI volume. The most common reason for conversion was left ventricular perforation (7/20, 35.0%). Thirty-day mortality was 35.0% in ECS patients. Kaplan-Meier survival curves showed that the cumulative survival rate was 65.0% at 1 year, 50.1% at 5 years in all ECS patients, and 77.1% at 5 years in patients who survived over 30 days after conversion.
Although the bail-out operation was performed immediately after TAVI abortion, ECS still associated with high 30-day mortality. The long-term survival benefit was seen in patients surviving from bail-out surgery. An experienced TAVI team is of crucial importance in avoiding ECS-related life-threatening complications and providing effective salvage surgery.
本研究旨在评估需要紧急将经导管主动脉瓣置换术（TAVI）转为开放性心脏手术的患者的短期和长期结局。此外，还报告了紧急心脏手术（ECS）的原因和程序设置。
我们回顾性分析了 2012 年至 2019 年在我院接受 TAVI 的患者的临床资料，并收集了转为紧急心脏手术的患者的临床资料。通过电话和门诊随访进行随访。
在 516 例 TAVI 患者中，有 20 例需要 ECS，随着 TAVI 量的增加，紧急心脏手术的发生率降低。转换的最常见原因是左心室穿孔（7/20，35.0%）。ECS 患者的 30 天死亡率为 35.0%。Kaplan-Meier 生存曲线显示，所有 ECS 患者的 1 年累积生存率为 65.0%，5 年生存率为 50.1%，在转为 ECS 后存活 30 天以上的患者中，5 年生存率为 77.1%。
尽管 TAVI 流产后立即进行了紧急手术，但 ECS 仍与 30 天死亡率高相关。从紧急心脏手术中存活下来的患者可获得长期生存获益。一个经验丰富的 TAVI 团队对于避免 ECS 相关的危及生命的并发症和提供有效的挽救性手术至关重要。
