Skip to main content
Skip main navigation
Sections

Introduction

Pineda et al. (1) should be congratulated for their paper about the incidence and outcomes of bailout surgery during transcatheter aortic valve replacement (TAVR). The incidence of 1% emergent surgery with a mortality rate of 50% at discharge raises doubts about the real advantage of onsite cardiac surgery (OSCS). These 47,546 patients’ outcomes join with those of the 17,979 in the AQUA (German Aortic Valve Replacement Quality Assurance) registry, 1,822 in the Austrian TAVI (Transcatheter Aortic Valve Implantation) Group, 384 in the Spanish Registry of TAVR without OSCS, and mainly, with 27,760 in the European Registry on Emergent Cardiac Surgery in TAVR. In the last, emergency surgery was needed in 0.76%, with mortality rates of 46% at discharge and only 40.4% of them alive at 1 year, restricting the advantage of OSCS to 1.64 of 1,000 patients (2). The figures provided by Pineda et al. (1) validate these results, and as occurred in the European Registry, the need of bailout surgery was reduced during the study period.

After almost 15 years performing TAVR, the better patient selection, improved technology, and increasing operator experience have reduced the bailout surgery to what were unimaginable rates a few years ago. Although we do not believe that TAVR should be performed in every hospital, the portrait has clearly changed, and TAVR should be allowed in centers without OSCS with both an experienced interventional and vascular surgery teams with autoexpandable valves in high-risk patients. Along this line, the Spanish Society of Cardiology, after having reviewed the available data, has rethought its recommendations (3). In our opinion, the study by Pineda et al. (1) represents remarkable proof that we should follow that way, which will help to solve one of the most challenging issues in TAVR—the accessibility of patients to the technique, given the demonstrated raise in cardiac death associated with the waiting lists (4).

References

  • 1. Pineda A.M., Harrison J.K., Kleiman N.S., et al. "Incidence and outcomes of surgical bailout during TAVR: insights from the STS/ACC TVT registry". J Am Coll Cardiol Intv 2019;12:1751-1764.

    View ArticleGoogle Scholar
  • 2. Eggebrecht H., Vaquerizo B., Moris C., et al. "Incidence and outcomes of emergent cardiac surgery during transfemoral transcatheter aortic valve implantation: insights from the European Registry on Emergent Cardiac Surgery during TAVI (EuRECS-TAVI)". Eur Heart J 2018;39:676-684.

    CrossrefMedlineGoogle Scholar
  • 3. Jimenez-Quevedo P., Pan M., Moreno R., et al. "Scientific evidence in the face of expert opinion. Should we modify the clinical practice guidelines?"Rev Esp Cardiol 2019. In press.

    Google Scholar
  • 4. Elbaz-Greener G., Masih S., Fang J., et al. "Temporal trends and clinical consequences of wait times for transcatheter aortic valve replacement". Circulation 2018;138:483-493.

    CrossrefMedlineGoogle Scholar

Footnotes

Please note: Dr. Moreno had the following relationships: proctoring support from Boston Scientific, Abbott, New Vascular Therapy, lectures and consultant for Medtronic, Biosensors, New Vascular Therapy, Boston Scientific, and Biotronik. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.