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Compagnone M, Dall'Ara G, Grotti S, Santarelli A, Balducelli M, Savini C, Tarantino FF, Galvani M. Transcatheter Aortic Valve Replacement Without On-Site Cardiac Surgery: Ready for Prime Time? JACC Cardiovasc Interv 2023; 16:3026-3030. [PMID: 38151317 DOI: 10.1016/j.jcin.2023.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 12/29/2023]
Affiliation(s)
| | | | - Simone Grotti
- Cardiology Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | | | - Marco Balducelli
- Cardiology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Carlo Savini
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy; Department of Medicine and Surgery of University of Bologna, Bologna, Italy
| | | | - Marcello Galvani
- Cardiology Unit, Morgagni Pierantoni Hospital, Forlì, Italy; Department of Medicine and Surgery of University of Bologna, Bologna, Italy; Cardiovascular Research Unit, Fondazione Cardiologica Sacco, Forlì, Italy
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Nasso G, Vignaroli W, Contegiacomo G, Marchese A, Fattouch K, D’Alessandro P, Brigiani MS, Vitobello V, Triggiani V, Demola MA, Tonioni S, Paparella D, Sechi S, Bonifazi R, Santarpino G, Resta F, Bartolomucci F, Lorusso R, Larosa C, Valenti G, Tito A, Moscarelli M, Margari V, Fiore F, Condello I, Speziale G. Emergent Conversion to Open Heart Surgery during Transcatheter Aortic Valve Implantation: The Presence of a Rescue Team Improves Outcomes. J Clin Med 2023; 12:7705. [PMID: 38137774 PMCID: PMC10743555 DOI: 10.3390/jcm12247705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/03/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE Transcatheter aortic valve implant (TAVI) is the gold standard for the high-surgical-risk group of patients with aortic valve disease and it is an alternative to surgery in patients at intermediate risk. Lethal complications can occur, and many of these are manageable only with emergent conversion to open heart surgery. We retrospectively evaluate the outcome of all patients undergoing TAVI in our departments and the impact of a complete cardiac rescue team to reduce 30-day mortality. METHODS Data from all patients undergoing TAVI between January 2020 and August 2023 in our center were analyzed. An expert complete rescue was present in catheter laboratory. Primary outcomes were in-hospital and at 30-day mortality and evaluation of all cases needed for emergent conversion to open heart surgery. RESULTS 825 patients were enrolled. The total mortality was 19/825 (2.3%). Eleven of the total patients (1.3%) required emergent conversion to open heart surgery. Among them, eight were alive (73%), with a theoretical decrease of 0.98% in overall mortality. CONCLUSIONS surgical treatment is rare during TAVI. The presence of an expert complete rescue team as support means an increase in survival. Surgery must be used only to restore circulatory and to treat complication while percutaneous approaches should complete the procedure.
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Affiliation(s)
- Giuseppe Nasso
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Walter Vignaroli
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00165 Roma, Italy; (K.F.); (S.T.); (S.S.)
| | - Gaetano Contegiacomo
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Alfredo Marchese
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy; (A.M.); (F.R.); (A.T.); (V.M.)
| | - Khalil Fattouch
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00165 Roma, Italy; (K.F.); (S.T.); (S.S.)
| | - Pasquale D’Alessandro
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Mario Siro Brigiani
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Vincenza Vitobello
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Vera Triggiani
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Maria Antonietta Demola
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Stefano Tonioni
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00165 Roma, Italy; (K.F.); (S.T.); (S.S.)
| | - Domenico Paparella
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy; (A.M.); (F.R.); (A.T.); (V.M.)
| | - Stefano Sechi
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00165 Roma, Italy; (K.F.); (S.T.); (S.S.)
| | - Raffaele Bonifazi
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Giuseppe Santarpino
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Fabrizio Resta
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy; (A.M.); (F.R.); (A.T.); (V.M.)
| | - Francesco Bartolomucci
- Department of Cardiology, Hospital of Andria, 76123 Andria, Italy; (F.B.); (C.L.); (G.V.)
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), 6229 HX Maastricht, The Netherlands;
| | - Claudio Larosa
- Department of Cardiology, Hospital of Andria, 76123 Andria, Italy; (F.B.); (C.L.); (G.V.)
| | - Giovanni Valenti
- Department of Cardiology, Hospital of Andria, 76123 Andria, Italy; (F.B.); (C.L.); (G.V.)
| | - Antonio Tito
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy; (A.M.); (F.R.); (A.T.); (V.M.)
| | - Marco Moscarelli
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Vito Margari
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy; (A.M.); (F.R.); (A.T.); (V.M.)
| | - Flavio Fiore
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Ignazio Condello
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
| | - Giuseppe Speziale
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (W.V.); (G.C.); (P.D.); (M.S.B.); (V.V.); (V.T.); (M.A.D.); (R.B.); (G.S.); (M.M.); (F.F.); (I.C.); (G.S.)
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00165 Roma, Italy; (K.F.); (S.T.); (S.S.)
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Hewitson LJ, Cadiz S, Al-Sayed S, Fellows S, Amin A, Asimakopoulos G, Barnes E, Beale A, Browne S, Chandrasekaran B, Dalby M, Foley P, Hawkins M, Haynes D, Heng EL, Hyde T, Kabir T, Khavandi A, Mirsadraee S, McCrea W, Petrou M, Senior R, Smith D, Smith R, Spartera M, Wamil M, Panoulas V, Rahbi H. Time to TAVI: streamlining the pathway to treatment. Open Heart 2023; 10:e002170. [PMID: 37666643 PMCID: PMC10481834 DOI: 10.1136/openhrt-2022-002170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 07/27/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Severe aortic stenosis is a major cause of morbidity and mortality. The existing treatment pathway for transcatheter aortic valve implantation (TAVI) traditionally relies on tertiary Heart Valve Centre workup. However, this has been associated with delays to treatment, in breach of British Cardiovascular Intervention Society targets. A novel pathway with emphasis on comprehensive patient workup at a local centre, alongside close collaboration with a Heart Valve Centre, may help reduce the time to TAVI. METHODS The centre performing local workup implemented a novel TAVI referral pathway. Data were collected retrospectively for all outpatients referred for consideration of TAVI to a Heart Valve Centre from November 2020 to November 2021. The main outcome of time to TAVI was calculated as the time from Heart Valve Centre referral to TAVI, or alternative intervention, expressed in days. For the centre performing local workup, referral was defined as the date of multidisciplinary team discussion. For this centre, a total pathway time from echocardiographic diagnosis to TAVI was also evaluated. A secondary outcome of the proportion of referrals proceeding to TAVI at the Heart Valve Centre was analysed. RESULTS Mean±SD time from referral to TAVI was significantly lower at the centre performing local workup, when compared with centres with traditional referral pathways (32.4±64 to 126±257 days, p<0.00001). The total pathway time from echocardiographic diagnosis to TAVI for the centre performing local workup was 89.9±67.6 days, which was also significantly shorter than referral to TAVI time from all other centres (p<0.003). Centres without local workup had a significantly lower percentage of patients accepted for TAVI (49.5% vs 97.8%, p<0.00001). DISCUSSION A novel TAVI pathway with emphasis on local workup within a non-surgical centre significantly reduced both the time to TAVI and rejection rates from a Heart Valve Centre. If adopted across the other centres, this approach may help improve access to TAVI.
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Affiliation(s)
| | - Suzane Cadiz
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | | | - Sarah Fellows
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alaaeldin Amin
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | | | - Edward Barnes
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Andrew Beale
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Suzy Browne
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | | | - Miles Dalby
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Paul Foley
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Mark Hawkins
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Douglas Haynes
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Ee Ling Heng
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Tom Hyde
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Tito Kabir
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Ali Khavandi
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | - William McCrea
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Mario Petrou
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Roxy Senior
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - David Smith
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Robert Smith
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Marco Spartera
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Vasileios Panoulas
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
- Cardiovascular Sciences, Imperial College London National Heart and Lung Institute, London, UK
| | - Hazim Rahbi
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
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Conzelmann L, Grotherr P, Dapeng L, Würth A, Widder J, Jacobshagen C, Mehlhorn U. Valve-Related Complications in TAVI Leading to Emergent Cardiac Surgery. Thorac Cardiovasc Surg 2023; 71:107-117. [PMID: 36446625 DOI: 10.1055/s-0042-1758073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is now a standard procedure for the treatment of symptomatic aortic valve stenosis in many patients. In Germany, according to the annual reports from the German Institute for Quality Assurance and Transparency in Healthcare (Institut für Qualitätssicherung und Transparenz im Gesundheitswesen), the rate of serious intraprocedural complications, such as valve malpositioning or embolization, coronary obstruction, aortic dissection, annular rupture, pericardial tamponade, or severe aortic regurgitation requiring emergency cardiac surgery has decreased markedly in recent years from more than 5.5% in 2012 to 2.0% in 2019. However, with increased use, the total number of adverse events remains about 500 per year, about 100 of which require conversion to sternotomy. These, sometimes, fatal events can occur at any time and are still challenging. Therefore, the interdisciplinary TAVI heart team should be prepared and aware of possible rescue strategies.
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Affiliation(s)
- Lars Conzelmann
- Department of Cardiac Surgery, HELIOS Clinic for Cardiac Surgery Karlsruhe, Karlsruhe, Germany
| | - Philipp Grotherr
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | - Lu Dapeng
- Department of Cardiology, Intensive Care Medicine and Angiology, Vincentius-Diakonissen Hospital Karlsruhe, Karlsruhe, Germany
| | - Alexander Würth
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | - Julian Widder
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | - Claudius Jacobshagen
- Department of Cardiology, Intensive Care Medicine and Angiology, Vincentius-Diakonissen Hospital Karlsruhe, Karlsruhe, Germany
| | - Uwe Mehlhorn
- Department of Cardiac Surgery, HELIOS Clinic for Cardiac Surgery Karlsruhe, Karlsruhe, Germany
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