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Transcatheter aortic valve implantation: when it`s time to convert
Philipp Kiefer, Joerg Seeburger, David Holzhey, Marcel Vollroth, Thilo Noack, Friedrich W. Mohr.
Heart Center Leipzig, Leipzig, Germany.

OBJECTIVE: Transcatheter aortiv valve implantation (TAVI) has emerged as an important treatment for patients with severe symptomatic aortic stenosis who are at high operative risk. Two different approaches-the transfemoral and transapical techniques-are currently under intense clinical investigation. Aim of this study was the evaluation of intraoperative complications and the conversion rate to full sternotomy.
METHODS: A total of 1825 (1153 transfemoral (TF), 672 transapical (TA)) patients underwent TAVI since July 2006 at our institution. Conversion to full sternotomy was required in 2.1 % of all patients (n=38; 21 TF and 17 TA). Patient data, including intraoperative course and postoperative outcome, were collected. Follow-up data were collected in a prospective database and retrospectively analized.
RESULTS: A total of 38 patients underwent conversion to full sternotomy during TAVI. The mean age of patients was 84.5±5.3 years, 32 patients were female (88%), and the mean log EuroScore was 21.7±16.3. The main reasons for conversion were as follows: perforation of the left ventricle in 26% (n=10; 6 TF, 4 TA); malpositioning of the valve in 24% (n=9; 5TF, 4 TA); occlusion of the coronaries in 18% (n=7; 3TF, 4TA); and rupture of the annulus in 18% of the patients (n=7; 5TF, 2TA). Perioperative mortality (30days) was 58% (n=23; 14 TF, 8 TA).
CONCLUSIONS: This trial indicates that TAVI is associated with reasonable low intraoperative complication rates. In the experience of this large single-center study, conversion to full sternotomy was necessary in only 2% of all patients. If conversion is indicated, however, it is associated with high perioperative risk.


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