Key result
Surgical bailout for TAVR complications carries high in-hospital mortality regardless of acute or chronic presentation.
Why the study?
With increasing TAVR procedures in lower-risk and younger patients, acute and chronic complications requiring surgical bailout need evaluation for efficacy and outcomes.
What are the outcomes and mortality rates of surgical bailout strategies for acute and chronic complications of TAVR?
Cohort (n=21)
No
What are the outcomes and mortality rates of surgical bailout strategies for acute and chronic complications of TAVR?
Absolute Event Rate: 36% vs 20%
p-value: p=0.64
Surgical bailout for TAVR complications carries significant mortality, with half of cases requiring complex procedures beyond simple valve explant and replacement.
Surgical bailout may aid select TAVR complications in high-volume centers; leaves open need for prospective data in lower-risk patients.
Background: 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. Methods: 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. Results: 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 (n = 4 [19%]) followed by left ventricular perforation (n = 3 [14%]). The most common chronic complication was early endocarditis (n = 5 [24%]). The most common bailout strategy was aortic valve replacement (AVR), which was sufficient in 10 patients (48%), followed by complete root replacement (n = 4 [19%]). In-hospital mortality was higher in acute compared with chronic complications albeit not statistically significant (n = 4 [36%] vs. n = 2 [20%], p = 0.64), highlighting the very high risk of all these surgeries. Conclusions: 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.
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Daprati et al. (2025) conducted a cohort in Complications from Transcatheter Aortic Valve Replacement (TAVR) (n=21). Acute complications requiring surgical bailout vs. Chronic complications requiring surgical bailout was evaluated on In-hospital mortality (p=0.64). Surgical bailout for TAVR complications resulted in high in-hospital mortality, with 36% for acute and 20% for chronic complications (p=0.64).
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