Frontiers in cardiovascular medicine · 2025
Conditional 1-year outcomes after emergent conversion to open heart surgery during transcatheter aortic valve implantation: a propensity-matched landmark analysis.
СтатьяНазвание и аннотация: Перевод в очереди
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Nasso Giuseppe, Vignaroli Walter, Contegiacomo Gaetano, Marchese Alfredo, Greco Ernesto, Fattouch Khalil, Bonifazi Raffaele, Fiore Flavio, Schinco Giacomo, Valenzano Antongiulio, Solimando Carlo, Margari Vito, Resta Fabrizio, Loizzo Tommaso, Hila Dritan, Paparella Domenico, Speziale Giuseppe
Аннотация
BACKGROUND: Emergent conversion to open heart surgery (E-OHS) during transcatheter aortic valve implantation (TAVI) is rare (0.5%-2%) but carries high perioperative mortality. Long-term outcomes in survivors beyond 30 days are not well defined.
OBJECTIVES: To assess 1-year conditional outcomes in patients who survived ≥30 days post-TAVI, comparing E-OHS survivors with propensity-matched uncomplicated TAVI recipients.
METHODS: Between January 2020 and August 2023, 825 consecutive TAVI procedures were performed at three Italian centers; 11 patients (1.3%) required E-OHS for catastrophic intraprocedural complications. A 30-day landmark analysis excluded early deaths (E-OHS: n = 3; controls: n = 25). Propensity matching (1:10) was performed on nine variables, yielding 8 E-OHS survivors and 80 well-matched controls.
PRIMARY ENDPOINT: All-cause mortality from day 31 to 1 year.
SECONDARY ENDPOINTS: Composite of death, moderate-or-greater paravalvular regurgitation, or valve reintervention; heart failure rehospitalization; permanent pacemaker; stroke/transient ischemic attack (TIA); and acute kidney injury (AKI).
RESULTS: Baseline characteristics were comparable. The mean age was 77 ± 5 years; EuroSCORE II was 6.8 ± 2.1%. One-year conditional mortality was 0% in E-OHS survivors vs. 2.9% in controls (p = 0.64). The composite endpoint occurred in 12.5% vs. 13.6% (p = 0.88). Other outcomes were similar: heart failure rehospitalization (12.5% vs. 11.2%), pacemaker implantation (12.5% vs. 9.6%), stroke/TIA (0% vs. 1.2%), and AKI (0% vs. 7.2%). No structural valve deterioration or thrombosis was observed.
CONCLUSIONS: E-OHS survivors who overcome the initial high-risk phase achieve 1-year outcomes comparable to standard TAVI patients. These findings support immediate surgical backup within TAVI programs and provide reassurance for high-risk patient counseling.
OBJECTIVES: To assess 1-year conditional outcomes in patients who survived ≥30 days post-TAVI, comparing E-OHS survivors with propensity-matched uncomplicated TAVI recipients.
METHODS: Between January 2020 and August 2023, 825 consecutive TAVI procedures were performed at three Italian centers; 11 patients (1.3%) required E-OHS for catastrophic intraprocedural complications. A 30-day landmark analysis excluded early deaths (E-OHS: n = 3; controls: n = 25). Propensity matching (1:10) was performed on nine variables, yielding 8 E-OHS survivors and 80 well-matched controls.
PRIMARY ENDPOINT: All-cause mortality from day 31 to 1 year.
SECONDARY ENDPOINTS: Composite of death, moderate-or-greater paravalvular regurgitation, or valve reintervention; heart failure rehospitalization; permanent pacemaker; stroke/transient ischemic attack (TIA); and acute kidney injury (AKI).
RESULTS: Baseline characteristics were comparable. The mean age was 77 ± 5 years; EuroSCORE II was 6.8 ± 2.1%. One-year conditional mortality was 0% in E-OHS survivors vs. 2.9% in controls (p = 0.64). The composite endpoint occurred in 12.5% vs. 13.6% (p = 0.88). Other outcomes were similar: heart failure rehospitalization (12.5% vs. 11.2%), pacemaker implantation (12.5% vs. 9.6%), stroke/TIA (0% vs. 1.2%), and AKI (0% vs. 7.2%). No structural valve deterioration or thrombosis was observed.
CONCLUSIONS: E-OHS survivors who overcome the initial high-risk phase achieve 1-year outcomes comparable to standard TAVI patients. These findings support immediate surgical backup within TAVI programs and provide reassurance for high-risk patient counseling.