title: Therapeutic alternatives after aborted sternotomy at the time of surgical aortic valve replacement in the TAVI Era-Five centre experience and systematic review.
abstract: BACKGROUND
  We aimed to analyze causes, management, and outcomes of the unexpected need to abort sternotomy in aortic stenosis (AS) patients accepted for surgical aortic valve replacement (SAVR) in the transcatheter aortic valve implantation (TAVI) era.
  
  
  METHODS
  Cases of aborted sternotomy (AbS) were gathered from 5 centers between 2009 and 2014. A systematic review of all published cases in the same period was performed.
  
  
  RESULTS
  A total of 31 patients (71% males, 74±8years, LogEuroSCORE 11.9±7.4%) suffered an AbS (0.19% of all sternotomies). Main reasons for Abs included previously unknown porcelain aorta (PAo) in 83.9%, mediastinal fibrosis due to radiotherapy in 12.9%, and chronic mediastinitis in 3.2%. Median time between AbS and next intervention was 2.3months (IQR: 0.7-5.8) with no mortality within this period. Only a case was managed with open surgery. In 30 patients (96.8%) TAVI was performed with a rate of success of 86.7%. Three patients (9.7%) presented in-hospital death and 17 (54.8%) had in-hospital complications including heart failure (9.6%), major bleeding (6.9%), and acute kidney injury (9.6%). Older patients (76±8 vs. 70±8years, p=0.045), previous cardiac surgery (60% vs. 15.4%, p=0.029), and shorter time from AbS to next intervention (5.1±5 vs. 1±0.7months, p=0.001) were related to higher six-month mortality (22.6%).
  
  
  CONCLUSIONS
  The main reason for AbS was PAo. This entity was associated to a higher rate of complications and mortality, especially in older patients and with prior cardiac surgery. A preventive strategy in these subgroups might be based on imaging evaluation. TAVI was the most extended therapy.
authors: Institute of Heart Sciences (ICICOR), Hospital Clínico Universitario, Valladolid, Spain.
authors: Javier
authors: J
authors: Castrodeza
authors: Institute of Heart Sciences (ICICOR), Hospital Clínico Universitario, Valladolid, Spain. Electronic address: ijamat@gmail.com.
authors: Ignacio J
authors: IJ
authors: Amat-Santos
authors: Cardiology Department, Hospital Vall d'Hebron, Barcelona, Spain.
authors: Vicenç
authors: V
authors: Serra
authors: Cardiology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain.
authors: Luis
authors: L
authors: Nombela-Franco
authors: Cardiac Surgery Department, Lenox Hill Hospital Northwell Health, NY, USA.
authors: Derek Ralph
authors: DR
authors: Brinster
authors: Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Enrique
authors: E
authors: Gutiérrez-Ibanes
authors: Institute of Heart Sciences (ICICOR), Hospital Clínico Universitario, Valladolid, Spain.
authors: Paol
authors: P
authors: Rojas
authors: Cardiology Department, Hospital Vall d'Hebron, Barcelona, Spain.
authors: Pilar
authors: P
authors: Tornos
authors: Cardiac Surgery Department, Hospital Clínico Universitario San Carlos, Madrid, Spain.
authors: Manuel
authors: M
authors: Carnero
authors: Institute of Heart Sciences (ICICOR), Hospital Clínico Universitario, Valladolid, Spain.
authors: Carlos
authors: C
authors: Cortes
authors: Institute of Heart Sciences (ICICOR), Hospital Clínico Universitario, Valladolid, Spain.
authors: Javier
authors: J
authors: Tobar
authors: Institute of Heart Sciences (ICICOR), Hospital Clínico Universitario, Valladolid, Spain.
authors: Salvatore
authors: S
authors: Di Stefano
authors: Institute of Heart Sciences (ICICOR), Hospital Clínico Universitario, Valladolid, Spain.
authors: Itziar
authors: I
authors: Gomez
authors: Institute of Heart Sciences (ICICOR), Hospital Clínico Universitario, Valladolid, Spain.
authors: José A
authors: JA
authors: San Román
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000453:epidemiology; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000453:epidemiology; D009026:Mortality; D010043:Outcome and Process Assessment, Health Care; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain; D056346:Sternotomy / Q000379:methods / Q000706:statistics & numerical data; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods / Q000706:statistics & numerical data
keywords: Aborted sternotomy; Porcelain aorta; Sutureless bioprosthesis; TAVI