Redo aortic valve surgery after TAVI procedure
Sergey Leontyev, Philip Kiefer, Norman Mangner, Axel Linke, Friedrich W. Mohr, David Holzhey.
Heart centre Leipzig, Leipzig, Germany.
OBJECTIVE: The aim of our study was to evaluate outcome in patients underwent delayed conventional aortic valve/root surgery after transcatheter aortic valve implantation (TAVI).
METHODS: A total of 17 patients underwent repeat aortic valve or aortic root surgery after TAVI between 2006 and 2013. During the TAVI procedure selfexpandable (n=10; 58.8 %) and balloonexpandable (n=7, 41.2%) valves were used. The indications for redo surgery was endocarditis (n=10, 58.8%), paravalvular leak (n=5, 29.4%), dislocation of valve (n=1, 5.9%) and aortic dissection (n=1, 5.9%). Time from initial implant ranged between 1-418 days.
RESULTS: The isolated aortic valve replacement (AVR) was performed in 7 (41.2%) patient. In all other patient extended surgery like AVR with aortic surgery (n=3, 17.6%), aortic root replacement (n=3; 17.6%) or aortic and mitral valve replacement (n=4, 23.5%) was necessary. In-hospital mortality was 29.4% (n=5) for all patients; 3 with endocarditis and one each other with paravalvular leak and acute dissection. Postoperative respiratory failure, renal failure, low cardiac output, stroke and sepsis occurred in 41.2 %, 35.3 %, 17.6%, 11.8% and 29.4% of patients, respectively. One year survival was 41±1% with estimated mean survival time 538±161 days.
CONCLUSIONS: Surgery after previously TAVI procedure is often associated with increased complexity. The most common reason for redo surgery after TAVI is endocarditis. Repeat isolated aortic valve and aortic root replacement surgery associated with poor outcomes.
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