Data regarding rescue cardiac surgery (RCS) complications during peripheral trans-aortic valve implantation (TAVI) are lacking.

We aim to assess the incidence, associated factors and outcomes of RCS complicating transfemoral TAVI.

Using data from the French hospital discharge national database, all consecutive peripheral TAVI performed in France between 2013 and 2022 were included. RCS was defined as emergency cardiac surgery carried out on the day of TAVI.

Overall, 106,699 patients were enrolled, including 790 (0.74%) RCS and 731 (0.69%) immediate death without RCS, on the day of TAVI procedure. RCS incidence significantly decreased over time from 1.34% in 2013 (45) to 0.61% in 2022 (109) (P for trend<0.001). Reasons for RCS were conversion to apical TAVI (119, 15.1%), sternotomy for hemostasis (349, 44.1%), surgery under bypass (260, 32.9%), and need for extra-corporeal life support (136 patients, 0.13%). Overall, in-hospital mortality rate was 30.6% among patients with RCS. After considering potential confounders, older age remained associated with a lower probability of RCS (OR=0.68 95% CI=0.64–0.73 per 10-year increment, P<0.001), but with a higher probability of immediate death without RCS (OR=1.54, 95% CI=1.37–1.75, P<0.001 per 10-years increments) (Fig. 1). Finally, older age was not significantly associated with a higher mortality rate in case of RCS (OR=1.15 95% CI=0.95–1.39 per 10-year increment, P=0.16).

RCS during TAVI rates remain rare and declined by half over the last decade, although the absolute number of RCS is increasing given the growing number of TAVI. More than two third of patients requiring RCS during TAVI may be finally discharged alive.