In:
Journal of Interventional Cardiology, Wiley, Vol. 28, No. 1 ( 2015-02), p. 76-81
Abstract:
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 . (J Interven Cardiol 2015;28:76–81)
Type of Medium:
Online Resource
ISSN:
0896-4327
,
1540-8183
Language:
English
Publisher:
Wiley
Publication Date:
2015
detail.hit.zdb_id:
2103585-4
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