Incidence and Outcomes of Surgical Bailout During TAVR: Insights From the STS/ACC TVT Registry.

Journal Article (Journal Article;Multicenter Study)

OBJECTIVES: The aim of this study was to evaluate the incidence and outcomes of surgical bailout during transcatheter aortic valve replacement (TAVR). BACKGROUND: The incidence and outcomes of unplanned conversion to open heart surgery, or "surgical bailout," during TAVR are not well characterized. METHODS: Data from the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry was analyzed with respect to whether surgical bailout was performed during the index TAVR procedure. A Cox proportional hazards models was used to evaluate 1-year mortality and major adverse cardiovascular events. RESULTS: Between November 2011 and September 2015, a total of 47,546 patients underwent TAVR. Surgical bailout during TAVR was performed in 1.17% of the cases (n = 558); the most frequent indications were valve dislodgement (22%), ventricular rupture (19.9%), and aortic valve annular rupture (14.2%). The incidence of surgical bailout significantly decreased over time (first tertile 1.25%, second tertile 1.43%, third tertile 1.04%; p = 0.0088). The 30-day and 1-year incidence of major adverse cardiovascular events (54.6% vs. 7.4% [p < 0.0001] and 63.92% vs. 20.29% [p < 0.0001]) and all-cause mortality (50.00% vs. 4.98% [p < 0.0001] and 59.79% vs. 17.06% [p < 0.0001]) were significantly higher in those who underwent bailout. Independent predictors of surgical bailout included female sex, hemoglobin, left ventricular ejection fraction, nonelective cases, and nonfemoral access. Body surface area was the only independent predictor of survival after surgical bailout. CONCLUSIONS: In a large, nationally representative registry, the need for surgical bailout in patients undergoing TAVR is low, and its incidence has decreased over time. However, surgical bailout after TAVR is associated with poor outcomes, including 50% mortality at 30 days.

Full Text

Duke Authors

Cited Authors

  • Pineda, AM; Harrison, JK; Kleiman, NS; Rihal, CS; Kodali, SK; Kirtane, AJ; Leon, MB; Sherwood, MW; Manandhar, P; Vemulapalli, S; Beohar, N

Published Date

  • September 23, 2019

Published In

Volume / Issue

  • 12 / 18

Start / End Page

  • 1751 - 1764

PubMed ID

  • 31537276

Electronic International Standard Serial Number (EISSN)

  • 1876-7605

Digital Object Identifier (DOI)

  • 10.1016/j.jcin.2019.04.026

Language

  • eng

Conference Location

  • United States