Conditional One-Year Outcomes after Emergent Conversion to Open Heart Surgery during Transcatheter Aortic Valve Implantation. A Propensity-Matched Landmark Analysis

Giuseppe Nasso^1*Walter Vignaroli¹Gaetano Contegiacomo¹Alfredo Marchese¹Ernesto Greco²Khalil Fattouch¹Raffaele Bonifazi¹Flavio Fiore¹Giacomo Schinco¹Antongiulio Valenzano¹Carlo Solimando¹Vito Margari¹Fabrizio Resta¹Tommaso Loizzo¹Dritan Hila¹Domenico Paparella³Giuseppe Speziale¹

• ¹Gruppo Villa Maria SpA, Lugo, Italy
• ²Universita Europea di Roma, Rome, Italy
• ³Universita degli Studi di Foggia, Foggia, Italy

Emergent conversion to open-heart surgery (E-OHS) during transcatheter aortic valve implantation (TAVI) is rare (0.5-2%) but carries high peri-operative mortality. Long-term outcomes in survivors beyond 30 days are not well defined.To assess 1-year conditional outcomes in patients who survived ≥30 days post-TAVI, comparing E-OHS survivors with propensity-matched uncomplicated TAVI recipients.Methods: From January 2020 to August 2023, 825 consecutive TAVI procedures were performed at three Italian centers; 11 patients (1.3%) required E-OHS for catastrophic intraprocedural complications. A 30-day landmark analysis excluded early deaths (E-OHS: n = 3; controls: n = 25). Propensity matching (1:10) was performed on nine variables, yielding 8 E-OHS survivors and 80 well-matched controls.All-cause mortality from day 31 to 1 year. Secondary endpoints: Composite of death, moderate-or-greater paravalvular regurgitation, or valve re-intervention; heart failure rehospitalization; permanent pacemaker; stroke/TIA; and acute kidney injury (AKI).Results: Baseline characteristics were comparable. Mean age was 77 ± 5 years; EuroSCORE II was 6.8 ± 2.1%. One-year conditional mortality was 0% in E-OHS vs 2.9% in controls (p = 0.64). The composite endpoint occurred in 12.5% vs 13.6% (p = 0.88). Other outcomes were similar: heart failure rehospitalization (12.5% vs 11.2%), pacemaker implantation (12.5% vs 9.6%), stroke/TIA (0% vs 1.2%), AKI (0% vs 7.2%). No structural valve deterioration or thrombosis was observed.Conclusions: E-OHS survivors who overcome the initial high risk phase achieve 1-year outcomes comparable to standard TAVI patients. These findings support immediate surgical backup within TAVI programs and provide reassurance for high-risk patient counselling.