Incidence and outcomes of surgical bailout for transcatheter aortic valve replacement

OBJECTIVES Intraprocedural complications of transcatheter aortic valve replacement (TAVR) continue to necessitate conversion to emergent open cardiac surgery. The need for on-site surgical backup remains debated. This study investigates the current incidence and outcomes of surgical conversions during TAVR in the United States. METHODS We queried the National Inpatient Sample Database to identify patients aged 18 and older who underwent percutaneous TAVR as the primary procedure between 2017 and 2021. Conversion was defined as any open cardiac surgery performed within one day following TAVR. We compared the characteristics and outcomes of patients with and without conversions and analyzed trends in conversion incidence and in-hospital mortality, as well as predictors of conversion and post-conversion mortality. RESULTS Our analysis included 68,141 TAVR patients, of whom 410 (0.6%) required conversion. The incidence of conversion increased from 0.50% to 0.68% (ptrend = 0.045). Post-conversion mortality decreased from 30.0% to 17.9% (ptrend = 0.006). The patients who underwent conversions were younger [73.9(12.4) vs 78.5(8.5), p < 0.001]. Risk factors for surgical conversion included liver disease [odds ratio (OR) 1.61, 95% confidence interval (CI) 1.12–2.31, p = 0.010], malnutrition (OR 3.15, 95% CI 1.91–5.17, p < 0.001), and rheumatic valve disease (OR 1.55, 95% CI 1.14–2.12, p = 0.006). Among converted cases, the incidence of cardiac bleeding and need for pericardiocentesis decreased from 40.0% to 24.8% (ptrend = 0.016) and 32.0% to 20.5% (ptrend = 0.015), respectively, while composite complications were constant. CONCLUSIONS The incidence of surgical conversion increased and post-conversion mortality decreased in the contemporary era. The overall risk profile and severe intraprocedural cardiac injuries have decreased in the TAVR cohort.