Background. In transcatheter aortic valve implantation (TAVI), intraprocedural complications which are only manageable by conversion to emergent open-heart surgery (E-OHS) occasionally occur. Contemporary data on the incidence and outcome of TAVI patients undergoing E-OHS are scarce.

          Methods. Data of all patients undergoing transfemoral TAVI between 2006 and 2020 at the Heart Centre Leipzig at University of Leipzig were analysed. The study time was divided into 3 periods: 2006-2010 (P1), 2011-2015 (P2), 2016-2020 (P3). Patients were grouped according to their surgical risk (high risk: EuroSCORE II ≥6%, n=66; low/intermediate risk: EuroSCORE II <6%, n=8). Primary outcomes were intraprocedural and in-hospital mortality as well as 1-year survival.

          Results. During the study period, a total of 6903 patients underwent transfemoral TAVI. Among them, 74 (1.1%) required E-OHS. The rate of patients requiring E-OHS was 3.5% (20/577 patients), 1.8% (35/1967 patients), and 0.4% (19/4359 patients) in study periods P1-P3, respectively (p<0.001). The proportion of E-OHS patients who were low/intermediate risk considerably increased over time (P1: 0%; P2: 8.6%; P3: 26.3%; p=0.077). Intraprocedural mortality occurred in 10 patients (13.5%), all of which were high-risk. In-hospital mortality was 62.1% in high-risk patients and 12.5% in low/intermediate risk patients (p=0.007). One-year survival was 37.8% in all patients undergoing E-OHS, 31.8% in high-risk patients, and 87.5% in low/intermediate risk patients (p=0.002).

          Conclusions. E-OHS in-hospital and 1-year survival rates are higher in low/intermediate risk than high risk patients. An on-site cardiac surgical department with immediately available E-OHS capabilities is an important component of the TAVI team.