Incidence and outcomes of emergent cardiac surgery during transfemoral transcatheter aortic valve implantation (TAVI): insights from the European Registry on Emergent Cardiac Surgery during TAVI (EuRECS-TAVI)

被引：98

作者：

Eggebrecht, Holger ^{[1
,2
]}

Vaquerizo, Beatriz ^{[3
]}

Moris, Cesar ^{[4
]}

Bossone, Eduardo ^{[5
]}

Laemmer, Johannes ^{[1
]}

Czerny, Martin ^{[6
]}

Zierer, Andreas ^{[7
]}

Schroefel, Holger ^{[6
]}

Kim, Won-Keun ^{[8
]}

Walther, Thomas ^{[8
]}

Scholtz, Smita ^{[9
]}

Rudolph, Tanja ^{[10
]}

Hengstenberg, Christian ^{[11
]}

Kempfert, Joerg ^{[12
]}

Spaziano, Marco ^{[13
]}

Lefevre, Thierry ^{[13
]}

Bleiziffer, Sabine ^{[14
]}

Schofer, Joachim ^{[15
,16
]}

Mehilli, Julinda ^{[17
,18
]}

Seiffert, Moritz ^{[19
]}

Naber, Christoph ^{[20
]}

Biancari, Fausto ^{[21
,22
]}

Eckner, Dennis ^{[23
]}

Cornet, Charles ^{[24
]}

Lhermusier, Thibault ^{[25
]}

Philippart, Raphael ^{[26
]}

Siljander, Antti ^{[27
]}

Cerillo, Alfredo Giuseppe ^{[28
]}

Blackman, Daniel ^{[29
]}

Chieffo, Alaide ^{[30
]}

Kahlert, Philipp ^{[31
]}

Czerwinska-Jelonkiewicz, Katarzyna ^{[32
]}

Szymanski, Piotr ^{[33
]}

Landes, Uri ^{[34
,35
]}

Kornowski, Ran ^{[34
,35
]}

D'Onofrio, Augusto ^{[36
]}

Kaulfersch, Carl ^{[37
]}

Sondergaard, Lars ^{[38
]}

Mylotte, Darren ^{[39
]}

Mehta, Rajendra H. ^{[40
,41
]}

De Backer, Ole ^{[38
]}

机构：

[1] AGAPLESION Bethanien Hosp, Dept Cardiol, CCB, Prufling 21-25, D-60389 Frankfurt, Germany

[2] Klinikum Fulda, Dept Cardiol, Herz Thorax Zentrum, Pacelliallee 4, D-36043 Fulda, Germany

[3] Hosp del Mar, Dept Cardiol, Unidad Cardiol Intervencionista, Passeig Maritim 25-29, Barcelona 08003, Spain

[4] Hosp Univ Cent Asturias, Area Corazon Hosp, Roma S-N, Oviedo, Asturias, Spain

[5] Univ Hosp, Cardiol Div, Cava deTirreni & Amalfi Coast Heart Dept, Via de Marinis 4, I-84013 Cava De Tirreni, Italy

[6] Univ Heart Ctr Freiburg Bad Krozingen, Dept Cardiovasc Surg, Sudring 15, D-79189 Bad Krozingen, Germany

[7] Kepler Univ Hosp, Dept Thorac & Cardiovasc Surg, Krankenhausstr 9, A-4021 Linz, Austria

[8] Kerckhoff Heart & Lung Ctr, Dept Cardiol & Cardiac Surg, Benekestr 2-8, D-61231 Bad Nauheim, Germany

[9] Ruhr Univ Bochum, Clin Cardiol, Herz & Diabeteszentrum Nordrhein Westfalen, Georgstr 11, D-32545 Bad Oeynhausen, Germany

[10] Univ Cologne, Heart Ctr, Dept Cardiol, Med Klin 3, Kerpener Str 3, D-50937 Cologne, Germany

[11] Med Univ Vienna, Dept Internal Med 2, Div Cardiol, Wahringer Gurtel 18-20, A-1090 Vienna, Austria

[12] Deutsch Herzzentrum Berlin, Dept Cardiac Surg, Augustenburger Pl 1, D-13353 Berlin, Germany

[13] Hop Prive Jacques Cartier, Dept Cardiol, Gen Sante, Inst Cardiovasc Paris Sud, 6 Ave Noyer Lambert, F-91300 Massy, France

[14] Tech Univ Munich, German Heart Ctr, Dept Cardiovasc Surg, Lazarettstr 36, D-80636 Munich, Germany

[15] Albertinen Heart Ctr, Medicare Ctr, Wordemannsweg 25-27, D-22527 Hamburg, Germany

[16] Albertinen Heart Ctr, Dept Percutaneous Treatment Struct Heart Dis, Wordemannsweg 25-27, D-22527 Hamburg, Germany

[17] Ludwig Maximilians Univ Munchen, Munich Univ Clin, Dept Cardiol, Munich, Germany

[18] German Ctr Cardiovasc Res DZHK, Partner Site Munich Heart, Munich, Germany

[19] Univ Heart Ctr Hamburg, Dept Gen & Intervent Cardiol, Martinistr 52, D-20246 Hamburg, Germany

[20] Elisabeth Krankenhaus Essen, Contilia Heart & Vasc Ctr, Dept Cardiol, Klara Kopp Weg 1, D-45134 Essen, Germany

[21] Univ Oulu, Dept Cardiol, Hameentie 11 POB 52, Turku 20521, Finland

[22] Univ Turku, Heart Ctr, Hameentie 11 POB 52, Turku 20521, Finland

[23] Paracelsus Med Univ Nuernberg, Gen Hosp Nuernberg, Dept Cardiol, Med Klin 8, Breslauer Str 201, D-90471 Nurnberg, Germany

[24] Univ Hosp Angers, Intervent Cardiol Unit, Cardiol Dept, 4 Rue Larry, F-49000 Angers, France

[25] Toulouse Univ Sch Med, Toulouse Rangueil Hosp, Dept Cardiol, 1 Prof Jean Poulhes Ave, F-31059 Toulouse, France

[26] Grp Cardiovasc Intervent Clin Pasteur, 45 Ave Lombez BP 27617, F-31076 Toulouse, France

[27] Kuopio Univ Hosp, Dept Cardiol, Heart Ctr, PL-100, Kys Kuopio 70029, Finland

[28] Fdn Toscana Gabriele Monasterio, UO Cardiochirurg Osped Cuore G Pasquinucci, Via Aurelia Sud, I-54100 Massa, Italy

[29] Leeds Teaching Hosp, Dept Cardiol, Leeds LS23 6AL, W Yorkshire, England

[30] Osped San Raffaele, Intervent Cardiol Unit, Olgettina St 60, I-20132 Milan, Italy

[31] Univ Hosp Essen, West German Heart & Vasc Ctr, Dept Cardiol, Hufelandstr 55, D-45147 Essen, Germany

[32] Amer Heart Poland Inc, Dept Cardiovasc Surg 1, Armii Krajowej 101 St, PL-43316 Bielsko Biala, Poland

[33] Natl Inst Cardiol, Valvular Heart Dis Dept, Alpejske 42, PL-06628 Warsaw, Poland

[34] Tel Aviv Univ, Cardiol Dept, Rabin Med Ctr, Jabotinski St 29, IL-39100 Tel Aviv, Israel

[35] Tel Aviv Univ, Cardiol Dept, Sackler Fac Med, Jabotinski St 29, IL-39100 Petah Tiqwa, Israel

[36] Azienda Osped Univ Padova, Dept Cardiac Thorac & Vasc Sci, Div Cardiac Surg, 2 Via Nicolo Giustiniani, I-35128 Padua, Italy

[37] Klinikum Klagenfurt, Dept Cardiol, Sankt Veiter Str 47, Klagenfurt Am, Germany

[38] Univ Copenhagen, Heart Ctr, Rigshosp, Dept Cardiol, Blegdamsvej 9, DK-2200 Copenhagen, Denmark

[39] Galway Univ Hosp, Dept Cardiol, Newcastle Rd, Galway, Ireland

[40] Duke Univ, Med Ctr, Div Cardiol, Dept Internal Med, 2400 Pratt St, Durham, NC 27715 USA

[41] Duke Clin Res Inst, 2400 Pratt St, Durham, NC 27715 USA

来源：

EUROPEAN HEART JOURNAL | 2018年 / 39卷 / 08期

关键词：

TAVI; TAVR; Complications; Conversion; Surgery; Death; ANNULUS RUPTURE; TEMPORAL TRENDS; REPLACEMENTS; METAANALYSIS; GERMANY; THERAPY; SOCIETY;

D O I：

10.1093/eurheartj/ehx713

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aims Life-threatening complications occur during transcatheter aortic valve implantation (TAVI) which can require emergent cardiac surgery (ECS). Risks and outcomes of patients needing ECS during or immediately after TAVI are still unclear. Methods and results Incidence, risk factors, management, and outcomes of patients requiring ECS during transfemoral (TF)-TAVI were analysed from a contemporary real-world multicentre registry. Between 2013 and 2016, 27 760 patients underwent TF-TAVI in 79 centres. Of these, 212 (0.76%) patients required ECS (age 82.4 +/- 6.3 years, 67.5% females, logistic EuroSCORE: 17.1%, STS-score 5.8%). The risk of ECS declined from 2013 (1.07%) to 2014 (0.70%) but remained stable since. Annual TF-TAVI numbers have more than doubled from 2013 to 2016. Leading causes for ECS were left ventricular perforation by the guidewire (28.3%) and annular rupture (21.2%). Immediate procedural mortality (< 72 h) of TF-TAVI patients requiring ECS was 34.6%. Overall in-hospital mortality was 46.0%, and highest in case of annular rupture (62%). Independent predictors of in-hospital mortality following ECS were age > 85 years [odds ratio (OR) 1.87, 95% confidence interval (95% CI) (1.02-3.45), P = 0.044], annular rupture [OR 1.96, 95% CI (0.94-4.10), P = 0.060], and immediate ECS [OR 3.12, 95% CI (1.07-9.11), P = 0.037]. One year of survival of the 114 patients surviving the in-hospital period was only 40.4%. Conclusion Between 2014 and 2016, the need for ECS remained stable around 0.7%. Left ventricular guidewire perforation and annular rupture were the most frequent causes, accounting for almost half of ECS cases. Half of the patients could be salvaged by ECS-nevertheless, 1 year of all-cause mortality was high even in those ECS patients surviving the in-hospital period.

引用

页码：676 / 684

页数：9

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