title: Safety of transcatheter aortic valve implantation in a hospital with visiting on-site cardiac surgery.
abstract: OBJECTIVE
  To describe the feasibility and safety of transcatheter aortic valve implantation (TAVI) with a visiting on-site cardiac surgery program for surgical back-up.
  
  
  BACKGROUND
  Both European and American guidelines recommend institutional cardiac surgery back-up for TAVI. However, the conversion to cardiac surgery is very rare, many complications of TAVI can be managed by catheter techniques and a visiting team can also provide surgical stand-by. Therefore, the need for institutional cardiac surgery (by a surgeon who routinely performs conventional surgical valve replacement at the institution performing TAVI) has been questioned.
  
  
  METHODS
  A retrospective review of consecutive TAVI cases with visiting on-site cardiac surgery was performed. Key demographic, echocardiographic, and procedural data were collected prospectively.
  
  
  RESULTS
  A total of 97 patients (81.9 ± 6.3 years) with high-risk criteria (log Euroscore 21.6 ± 14.4, chronic renal failure 39.2%, severe systolic dysfunction 24.7%) underwent TAVI with visiting on-site cardiac surgery at our institution. Local anesthesia with or without conscious sedation was used in 94.8% of patients. Procedural technical success was 100%, with 2 episodes of tamponade (both treated with pericardiocentesis) and a 16.5% vascular complication rate (all treated conservatively or percutaneously). Thirty-day mortality was 3.1%, with 5.2% rate of stroke and 8.2% rate of major bleeding. There were no conversions to surgery.
  
  
  CONCLUSIONS
  TAVI can be done safely in the setting of a hospital with visiting on-site cardiac surgery. This requires careful patient selection, experienced operators and surgeons in experienced centers with well-established criteria and processes of care. In this setting, it may be an option for hospitals without institutional cardiac surgery.
authors.affiliation: CardioVascular Center, Frankfurt, Germany.
authors.forename: Sameer
authors.initials: S
authors.lastname: Gafoor
authors.forename: Margarita
authors.initials: M
authors.lastname: Sirotina
authors.forename: Mirko
authors.initials: M
authors.lastname: Doss
authors.forename: Jennifer
authors.initials: J
authors.lastname: Franke
authors.forename: Kerstin
authors.initials: K
authors.lastname: Piayda
authors.forename: Simon
authors.initials: S
authors.lastname: Lam
authors.forename: Stefan
authors.initials: S
authors.lastname: Bertog
authors.forename: Laura
authors.initials: L
authors.lastname: Vaskelyte
authors.forename: Ilona
authors.initials: I
authors.lastname: Hofmann
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D061214:Patient Safety; D012189:Retrospective Studies; D066231:Surgeons; D065467:Transcatheter Aortic Valve Replacement