Emergent Cardiac Surgery After Transcatheter Structural Heart Procedures: Narrative Review

Transcatheter structural heart procedures have become standard therapy for elderly patients with high surgical risk. Over time, these procedures have significantly increased worldwide, accompanied by a concomitant reduction of major complications, including those requiring emergent cardiac surgery (ECS). This marked decline in ECS is due to technological advancements, improved patient selection and procedural techniques, and increased institutional and operators expertize. Moreover, most major structural complications after transcatheter structural heart procedures are now managed percutaneously, with only a small proportion requiring ECS. It is important to note that outcomes for patients requiring ECS remain unfavorable, even in the optimal setting. Currently, ECS after percutaneous structural interventions is very rare, less than 0.5%, as reported in multicenter available studies. However, fragmented data exist in the literature on the need of ECS. Indeed, low incidence, different definitions, and lack of recent reports make it difficult to have a precise and up-to-date overview of bailout surgery for treatment of procedural complications. This is the first comprehensive analysis focusing on ECS following the major frequent percutaneous structural procedures, that is, transcatheter aortic valve replacement, mitral valve repair/replacement, and left atrial appendage occlusion. More in general, a collaborative approach among Heart Team members, along with thorough procedural planning guided by advanced imaging techniques, is essential for ensuring high-quality interventions thus minimizing the risk of adverse events.