Aborted sternotomy in the modern era of transcatheter aortic valve replacement

Introduction: Some patients with symptomatic aortic stenosis undergo sternotomy and have the operation aborted because of intraoperative discovery of unexpected severe calcification of the aorta. The aim of this study is to present our experience and analyze the causes, the management, and the outcomes of these patients. Methods: This is a retrospective study. Between January 2010 and December 2017 10565 patients underwent cardiac surgery, 27 patients (0.3%) had aborted sternotomy, of whom seven patients with severe aortic stenosis. The reason was unexpected intraoperative discovery of severe calcified ascending aorta that precluded placing of an aortic cross-clamp. Following the aborted sternotomy, based on the heart team's decision, 2 patients were referred for conservative treatment, 5 patients underwent transcatheter aortic valve replacement. The mean and median follow-up times were 33 +/- 20 and 39 (0-54) months respectively. Results: Mean and median time between the aborted sternotomy and the next intervention were 2.6 +/- 1.4 and 2 (1-5) months respectively with no mortality within this period. The total long-term mortality was 4/7 patients (57.14%). Both patients (100%) who were referred for conservative treatment, as well as two of the five patients (40%) that had undergone TAVR, died during follow-up. Conclusions: Aborted sternotomy had higher hospital and long-term mortality. Transcatheter aortic valve replacement, despite the relative high long-term mortality, had a better effect on the survival compared to the patients who were offered only conservative treatment. A preventive strategy in these high risk patients might be based on routine preoperative chest computer tomography imaging.