Predictors and outcome of conversion to cardiac surgery during transcatheter aortic valve implantation

Mani Arsalan, Won Keun Kim, Arnaud Van Linden, Christoph Liebetrau, Benjamin D. Pollock, Giovanni Filardo, Mathias Renker, Helge Möllmann, Mirko Doss, Ulrich Fischer-Rasokat, Adalbert Skwara, Christian W. Hamm, Thomas Walther

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: Due to increasing clinical experience with transcatheter aortic valve implantation (TAVI) procedures, sophisticated imaging and advanced device technology, TAVI complication rates are low; however, patients requiring conversion to surgery are confronted with an increased mortality risk. In this retrospective study, we evaluated the predictors for conversion and the outcomes of these patients. METHODS: We analysed the records of all patients undergoing TAVI in our centre from 2011 to 2016 and focused on cases that required conversion to sternotomy. We investigated reasons and risk factors for conversion as well as 30-day and 1-year outcomes. RESULTS: During the study period, 32 (2.1%) of 1775 patients undergoing TAVI required immediate conversion to sternotomy. Annular rupture (5 of 32; 16%), device embolization (9 of 32; 28%) and pericardial tamponade (15 of 32; 47%) were the most common reasons for conversion. Usage of a self-expandable valve showed to be the only predictor for conversion (odds ratio 0.38, 95% confidence interval 0.16-0.90; P = 0.03). Survival at 30 days and 1 year was 56% and 41%, respectively. Patients who survived 30 days after conversion showed higher preoperative ejection fraction, shorter duration of surgery and shorter perfusion time. CONCLUSIONS: In this high-volume, single-centre experience, conversion to sternotomy during TAVI occurred in about 2%, with annular rupture, device embolization and pericardial tamponade being the most common causes. Complications requiring conversion showed to be unpredictable. However, in view of these life-threatening complications, the 30-day survival rate exceeding 50% emphasizes the importance of an experienced and well-attuned heart team providing immediate access to surgical bailout procedures.

Original languageEnglish (US)
Pages (from-to)267-272
Number of pages6
JournalEuropean Journal of Cardio-Thoracic Surgery
Issue number2
StatePublished - Aug 1 2018


  • Complications
  • Conversion
  • Sternotomy
  • Transcatheter aortic valve implantation
  • Transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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