Outcomes of Surgically Treated Complications Caused by Cardiovascular Interventions

Background: Despite reported low complication rates, the high volume of cardiovascular interventional procedures performed nowadays leads to a significant number of patients suffering from potentially life-threatening complications. This study investigates the outcomes of patients suffering from complications caused by cardiovascular interventional procedures, which required cardiac surgical rescue.

Method: This single-center retrospective study analyzes the outcomes of 49 patients, who required cardiac surgical treatment of complications caused by interventional procedures. The following baseline procedures were included: cardiac catheterization and percutaneous coronary intervention (PCI), electrophysiological studies, and catheter ablations such as pulmonary vein isolation (PVI), MitraClip and LAA-occluder implantation.

Results: Between April 2017 and December 2020, a total of 51 patients were admitted to our center due to complications of cardiovascular interventions. One patient with iatrogenic aortic dissection died prior to surgical rescue due to severe refractory cardiogenic shock on arrival. One patient did not require surgery after drainage of pericardial tamponade by percutaneous pericardiocentesis. Forty-nine patients required immediate cardiac surgical rescue procedures. The two most frequent entities, which led to complications needing emergent surgical treatment were PCI (36.7%; 18/49) and PVI (32.7%; 16/49). Complications resulting from PCI were mainly dissections or perforations of coronary arteries (55.6%; 10/18) and type A aortic dissections (27.8%; 5/18). Pericardial tamponade (87.5%; 14/16) with active bleeding from myocardial or vascular perforation in all cases was the main reason for surgical treatment after PVI. The mean duration of ICU stay was 6.8 ± 3.8 days and average hospital stay was 9.3 ± 4.4 days. Operative mortality occurred in one patient (2.0%) and 30-day mortality was 14.3% (7/49).

Conclusion: Despite low operative mortality, complications occurring during interventional cardiovascular procedures carry a high postoperative mortality caused by the consequences of preoperative hemodynamic compromise. Therefore, immediate access to cardiac surgery appears to be important in the management of such complications.

Publication History

Article published online:
03 February 2022