Abstract 13525: Acute Surgical Conversion during Transcatheter Aortic Valve Implantation (TAVI) - A Weighted Meta-Analysis of 9,251 Patients from 46 Studies
Background. Transcatheter aortic valve implantation (TAVI) is a novel treatment option for high surgical risk patients (pts) with severe symptomatic aortic valve (AV) stenosis. During TAVI, some pts may require acute conversion to surgery. However, the incidence, reasons and outcomes of those needing such acute conversion remain unknown.
Methods and results. We performed search of the English medical literature using MEDLINE to identify all studies on TAVI to study the incidence of acute surgical conversion (i.e within 24 hrs of TAVI) and outcomes in these pts. Forty-six studies comprising of 9,251 pts undergoing transfemoral, transapical (TA) or transsubclavian TAVI for native AV stenosis published between 01/2004 and 04/2012 were identified and included in a weighted meta-analysis. Overall, TAVI pts were 81.3±5.4 yrs old and had a high mean logistic EuroSCORE (24.4±5.9%). Few pts required acute surgical conversion (n=102; 1.1±1.1%) and this was marginally higher among those undergoing TA-TAVI as compared to those undergoing transarterial TAVI (1.9±1.7% vs. 0.6±0.9%). Few studies reported cause of such conversions and >50% of these were performed for embolisation/dislocation of AV prosthesis, with aortic dissection, coronary obstruction, AV regurgitation, annular rupture, and tamponade constituting the rest (Figure). 30-day death was about 8-fold higher in pts who did compared to those who did not need conversion (48.0±44.3% vs. 6.5±4.5%).
Conclusions. Reported rates of acute surgical conversion during TAVI were low with most common cause for it stated as embolization/dislocation of prosthesis. Conversion was associated with grave prognosis with half of these pts dying at 30 days. Thus, refinement in TAVI technology should not only focus on miniaturization of delivery system, which has the potential for decreasing aortic dissection, annular rupture, and tamponade, but also incorporate modifications to prevent embolization/dislocation of the valve.
- © 2012 by American Heart Association, Inc.