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Craig R Smith, Emergency cardiac surgery following TAVI: implications for the future, European Heart Journal, Volume 39, Issue 8, 21 February 2018, Pages 685–686, https://doi.org/10.1093/eurheartj/ehx773
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Extract
This editorial refers to ‘Incidence and outcomes of emergency cardiac surgery during transfemoral transcatheter aortic valve implantation (TAVI): insights from the European Registry on Emergent Cardiac Surgery during TAVI (EuRECS-TAVI)’†, by H. Eggebrecht et al., on page 676.
In this issue, the European Registry on Emergent Cardiac Surgery during TAVI (EuRECS-TAVI) presents the world’s first large reported experience with emergent cardiac surgery following transfemoral transcatheter aortic valve implantation (TF-TAVI).1 During the 4-year period from 2013 through 2016, the frequency of TAVI more than doubled in the 79 centres represented, generating a cohort of 27 760 TF-TAVI patients, of whom 211 (0.76%) required emergency cardiac surgical procedures (ECS). Though distinctly infrequent, the need for ECS was highly consequential. Mortality was 34.6% within 72 h, 46% within the hospital stay, and 78% at 1 year. Is such high mortality a consequence of TAVI being the treatment of choice in the elderly and high risk, while surgery still reigns at the young and healthy end of the spectrum? Indeed, the average age of ECS patients was 82 and two-thirds were female; however, the average risk pre-TAVI was solidly in the intermediate range, and only 23% were considered high risk. Is dispersion of TAVI to new, low volume centres making complications more lethal? Perhaps not—low volume centres in EuRECS (annual median 28 TF-TAVI) appeared to perform as well as high volume centres (annual median 116 TF-TAVI), although the data do not reveal how many low volume centres are included.
