title: Outcome of patients after emergency conversion from transcatheter aortic valve implantation to surgery.
abstract: OBJECTIVE
  To evaluate: 1) the causes of emergency conversion from transcatheter aortic valve implantation (TAVI) to surgery, 2) procedural settings, and 3) short-term outcome of converted patients.
  
  
  RESULTS
  The prospective German TAVI registry was used to identify patients who underwent bail-out surgery during TAVI. Additionally, standardised questionnaires were developed and used to assess more detailed periprocedural and postprocedural data. Emergency conversion from TAVI to open cardiac surgery was required in 24 of 1,975 patients (1.2%). Primary conversion causes were aorto-valvular complications (i.e., aortic annulus rupture, aortic perforation, or thoracic aortic dissection). This was followed by prosthesis embolisation, myocardial perforation, severe aortic regurgitation, and coronary obstructions. The mean time interval between abortions of TAVI to surgery was 19 minutes (SD ± 17 min, range 5-80 min). Four of 24 patients (16.7%) died during the initial surgery, seven of 24 (29.2%) within the first 72 hours and the 30-day mortality was 45.8%. The highest mortality was observed in patients with aortic perforation or dissection (4/5, 80%). Mortality rates for other entities were: prosthesis embolisation 40% (2/5), myocardial perforation 50% (2/4), annulus rupture 67% (2/3), severe aortic regurgitation 33% (1/3), and coronary impairment 0% (0/3).
  
  
  CONCLUSIONS
  Emergency conversion from TAVI to surgery is a rare event carrying a mortality of around 45% after 30 days. Outcome of converted patients with prior injury of aortic, aorto-valvular, or myocardial tissue during TAVI was poor, whereas patients with severe aortic regurgitation and those with coronary complications had a more favourable outcome after 30 days. Collected procedural and outcome data demand on-site cardiac surgery as a prerequisite for TAVI and constant process optimisation efforts regarding such emergency scenarios.
authors: Städtisches Klinikum München GmbH, Klinikum Neuperlach, Department of Cardiology, Munich, Germany.
authors: Ralph
authors: R
authors: Hein
authors: Mohamed
authors: M
authors: Abdel-Wahab
authors: Horst
authors: H
authors: Sievert
authors: Karl-Heinz
authors: KH
authors: Kuck
authors: Matthias
authors: M
authors: Voehringer
authors: Rainer
authors: R
authors: Hambrecht
authors: Stefan
authors: S
authors: Sack
authors: Karl E
authors: KE
authors: Hauptmann
authors: Jochen
authors: J
authors: Senges
authors: Ralf
authors: R
authors: Zahn
authors: Harald
authors: H
authors: Mudra
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design / Q000379:methods; D012042:Registries; D016896:Treatment Outcome