Daprati Andrea, Garatti Andrea, Guerrini Marco, Sisinni Antonio, Arzuffi Luca, Soma Federico, de Vincentiis Carlo, Menicanti Lorenzo
Cardiac Surgery Unit, IRCCS Policlinico S. Donato, 20097 Milan, Italy.
Clinical and Interventional Cardiology Department, IRCCS Policlinico S. Donato, 20097 Milan, Italy.
J Clin Med. 2025 Apr 28;14(9):3051. doi: 10.3390/jcm14093051.
Transcatheter aortic valve replacement (TAVR) is at the forefront of structural heart programs all over the world. With a growing number of TAVR procedures in lower-risk and younger patients, acute and chronic complications require decisive treatment. The aim of the present study is to retrospectively analyze the efficacy of surgical bailout strategies in case of complications from TAVR that had been performed in the highest-volume center in Italy over the past ten years. Acute complications were defined as events occurring in the first 24 h after surgery, while chronic complications were defined as events occurring within the first year post-implant. We retrospectively analyzed the 2731 patients who had undergone TAVR at our institution from January 2015 to August 2024. A total of 21 patients were included, with a median age of 78 years (IQR 11y). The majority of patients underwent TAVR with a self-expanding prosthesis (76%). A total of 11 patients (52%) presented acute complications, of which the most common were aortic dissection ( = 4 [19%]) followed by left ventricular perforation ( = 3 [14%]). The most common chronic complication was early endocarditis ( = 5 [24%]). The most common bailout strategy was aortic valve replacement (AVR), which was sufficient in 10 patients (48%), followed by complete root replacement ( = 4 [19%]). In-hospital mortality was higher in acute compared with chronic complications albeit not statistically significant ( = 4 [36%] vs. = 2 [20%], = 0.64), highlighting the very high risk of all these surgeries. Bailout and post-TAVR surgery are critical issues, with overall acceptable yet significant mortality considering the very high risk of these procedures. In our experience, half of the overall complications cannot be resolved with a simple explant and subsequent valve replacement, thereby underlining the importance of skilled cardiothoracic surgery teams on site to address complex issues such as ventricular perforation and emergency aortic/root replacement.
经导管主动脉瓣置换术（TAVR）处于全球结构性心脏病治疗项目的前沿。随着越来越多的低风险和年轻患者接受TAVR手术，急性和慢性并发症需要果断治疗。本研究的目的是回顾性分析意大利手术量最大的中心在过去十年中进行的TAVR术后出现并发症时手术补救策略的疗效。急性并发症定义为术后24小时内发生的事件，而慢性并发症定义为植入后第一年内发生的事件。我们回顾性分析了2015年1月至2024年8月在我院接受TAVR手术的2731例患者。共纳入21例患者，中位年龄78岁（四分位间距11岁）。大多数患者接受了自膨胀式人工瓣膜的TAVR手术（76%）。共有11例患者（52%）出现急性并发症，其中最常见的是主动脉夹层（n = 4 [19%]），其次是左心室穿孔（n = 3 [14%]）。最常见的慢性并发症是早期心内膜炎（n = 5 [24%]）。最常见的补救策略是主动脉瓣置换术（AVR），10例患者（48%）采用该策略有效，其次是全根部置换术（n = 4 [19%]）。急性并发症患者的院内死亡率高于慢性并发症患者，尽管差异无统计学意义（n = 4 [36%] 对 n = 2 [20%]，P = 0.64），这突出了所有这些手术的极高风险。补救手术和TAVR术后手术是关键问题，考虑到这些手术的极高风险，总体死亡率虽可接受但仍显著。根据我们的经验，一半的总体并发症无法通过简单的取出和随后的瓣膜置换来解决，从而强调了现场熟练的心胸外科团队处理诸如心室穿孔和紧急主动脉/根部置换等复杂问题的重要性。
