Focus on the surgical approach to transcatheter XXXX : Complications, outcome, and preoperative risk adjustment.

@entity1 @entity583 @entity548 @entity886 @entity4207 @entity810 @entity453
OBJECTIVE: Perioperative complications in @entity1 undergoing transcatheter @entity886 remain a major issue affecting outcome. Because preoperative risk adjustment remains challenging and a valid scoring system is missing, we sought to determine the incidence of peri- and postprocedural complications of transapical (TA) or transaortic (TAO) access to define the influence of specific complications on early safety, 30-day mortality, and 1-year survival. Furthermore, we aimed to develop a risk-stratification model to allow an estimation of the perioperative risk and the 1-year survival rate, based on the individual preoperative condition of each @entity1 . METHODS: We performed an outcome analysis of 230 consecutive @entity1 who underwent @entity886 via transapical or transaortic access between 2008 and 2012, with regard to Valve @entity4207 , including univariate and multivariable regression analysis, to develop a risk-stratification model. RESULTS: Thirty-day mortality was 12.7%. Estimated 1-year survival was 0.69 (95% confidence interval [CI], 0.631-0.757), and 3-year survival was 0.554 (95% CI, 0.474-0.634). Univariate logistic regression analysis revealed a significant influence on 30-day mortality in case of life-threatening @entity548 (16.1-fold), abdominal complications (8.5-fold), and @entity810 (3.2-fold). Pacemaker implantation (odds ratio, 1.55; 95% CI, 0.42-5.81; P  =  .512) was not a significant predictor. Concerning use of intraprocedural hemodynamic bridging therapy via cardiopulmonary bypass (CPB), Cox regression analysis revealed no significant survival difference after 1  year. A preoperative risk-stratification model for 1-year survival revealed that a logistic European System for Cardiac Operative Risk Evaluation score >20%, preoperative existing @entity453 , and prior @entity583 appeared to be significant predictors for diminished survival. CONCLUSIONS: Concerning intraprocedural complications, CPB support for hemodynamic stabilization is a safe treatment option. Therefore, the heart team approach with CPB standby represents a life-saving option. Attention should also be drawn to  specialized and individual postoperative care, because nonprocedure-specific complications clearly affect postoperative short- and long-term outcome. In addition, the risk-stratification model might facilitate preoperative decision making.
