Key result
Major intraprocedural complications occurred in 7.6% of patients undergoing TAVI, with a 30-day mortality of 31.4% among those affected.
Why the study?
What is the incidence and outcome of severe intraprocedural complications requiring bailout maneuvers during TAVI?
Cohort (n=458)
What is the incidence and outcome of severe intraprocedural complications requiring bailout maneuvers during TAVI?
Severe intraprocedural complications during TAVI occur in approximately 7.6% of cases and carry high 30-day mortality, highlighting the critical need for an interdisciplinary heart team to provide a surgical and interventional safety net.
Answers are grounded in this paper and cite their sources.
TAVI complications carry high short-term mortality, underscoring preparedness; leaves open which protocols or team structures improve bailout survival.
OBJECTIVES: Transcatheter aortic valve implantation (TAVI) has emerged rapidly. Despite unanimous recommendations and potentially fatal intraoperative complications, the heart-team approach is not comprehensively adopted by all centres. We sought to characterize severe intraprocedural complications during TAVI requiring immediate surgical or interventional bailout manoeuvres and evaluate outcomes. METHODS: TAVI was performed in 458 consecutive patients using a balloon-expandable or self-expanding valve through transfemoral and transapical approaches. Severe intraprocedural complications requiring intraoperative bailout manoeuvres were analysed according to the Valve Academic Research Consortium (VARC) criteria. RESULTS: Thirty-five of 458 patients (7.6%) experienced 40 major intraprocedural complications during TAVI, 13 (2.8%) requiring emergent conversion to surgery. Complications included valve embolization/migration (17%), severe aortic regurgitation (12%) and root rupture (5%), requiring immediate implantation of a second valve or conversion to surgical valve replacement. Sternotomy and surgical haemostasis were performed in 5 patients (13%) with left ventricular wire perforation and subsequent cardiac tamponade. Coronary obstruction (15%) required emergent percutaneous coronary intervention in 6 patients. At 30 days, all-cause mortality was 31.4% in patients with intraprocedural complications and 38.5% in patients requiring surgical conversion. However, mid-term survival after 30 days and exercise tolerance in surviving patients were comparable with patients undergoing uncomplicated TAVI. CONCLUSIONS: An interdisciplinary approach to TAVI facilitated bailout procedures accomplishing acceptable outcomes, despite severe intraprocedural complications. These bailout manoeuvres in potentially fatal complications were only accomplished through an interdisciplinary heart-team effort, creating a surgical and interventional safety net, which should be established in all centres performing TAVI procedures.
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Seiffert et al. (2013) conducted a cohort in Transcatheter aortic valve implantation (TAVI) (n=458). Transcatheter aortic valve implantation (TAVI) was evaluated on Major intraprocedural complications. Major intraprocedural complications occurred in 7.6% of patients undergoing TAVI, with a 30-day mortality of 31.4% among those affected.
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