Impact of On-Site Cardiac Surgery on Clinical Outcomes After Transfemoral Transcatheter Aortic Valve Replacement

Austrian TAVI Group, Miklos Rohla, Paul Vock, Gudrun Lamm

Research output: Journal article (peer-reviewed)Journal article

11 Citations (Scopus)

Abstract

OBJECTIVES: This study sought to investigate the outcome of high-risk and inoperable patients with severe symptomatic aortic stenosis undergoing transfemoral transcatheter aortic valve replacement (TAVR) in hospitals with (iOSCS) versus without institutional on-site cardiac surgery (no-iOSCS).

BACKGROUND: Current guidelines recommend the use of TAVR only in institutions with a department for cardiac surgery on site.

METHODS: In this analysis of the prospective multicenter Austrian TAVI registry, 1,822 consecutive high-risk patients with severe symptomatic aortic stenosis undergoing transfemoral TAVR were evaluated. A total of 290 (15.9%) underwent TAVR at no-iOSCS centers (no-iOSCS group), whereas the remaining 1,532 patients (84.1%) were treated in iOSCS centers (iOSCS group).

RESULTS: Patients of the no-iOSCS group had a higher perioperative risk defined by the logistic EuroSCORE (20.9% vs. 14.2%; p < 0.001) compared with patients treated in hospitals with iOSCS. Procedural survival was 96.9% in no-iOSCS centers and 98.6% in iOSCS centers (p = 0.034), whereas 30-day survival was 93.1% versus 96.0% (p = 0.039) and 1-year survival was 80.9% versus 86.1% (p = 0.017), respectively. After propensity score matching for confounders procedural survival was 96.9% versus 98.6% (p = 0.162), 93.1% versus 93.8% (p = 0.719) at 30 days, and 80.9% versus 83.4% (p = 0.402) at 1 year.

CONCLUSIONS: Patients undergoing transfemoral TAVR in hospitals without iOSCS had a significantly higher baseline risk profile. After propensity score matching short- and long-term mortality was similar between centers with and without iOSCS.

Original languageEnglish
Pages (from-to)2160-2167
Number of pages8
JournalJACC: Cardiovascular Interventions
Volume11
Issue number21
DOIs
Publication statusPublished - 12 Nov 2018

Keywords

  • Aged
  • Aged, 80 and over
  • Aortic Valve Stenosis/diagnostic imaging
  • Austria
  • Cardiac Surgical Procedures
  • Cardiology Service, Hospital
  • Catheterization, Peripheral/adverse effects
  • Female
  • Femoral Artery
  • Humans
  • Male
  • Prospective Studies
  • Registries
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Time Factors
  • Transcatheter Aortic Valve Replacement/adverse effects
  • Treatment Outcome
  • TAVR
  • on-site cardiac surgery
  • aortic stenosis
  • transfemoral

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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