Major Intraprocedural Complications during Transcatheter Aortic Valve Implantation requiring Emergent Cardiac Surgery: an updated Systematic Review

Transcatheter aortic valve implantation (TAVI) is an established treatment for patients >75 years old with severe aortic stenosis. From the technique's beginnings in the early 2000s, over 20 years of experience in the TAVI procedure have allowed its wide diffusion with optimal procedural results. Intraprocedural complications during TAVI are yet a fearful scenario, sometimes requiring emergent open-heart surgery (EOHS) that is burdened by high intraoperative mortality (50% at 30 days). Furthermore, also when a surgical treatment is not needed, intraprocedural complications have a challenging management and a critical impact on patients' prognosis. The volume of procedures in the last 10 years has been observed to increase substantially, with an incidence of major intraprocedural complications of around 1%. However, the features and specific incidence for each complication have not been revised recently. This work aims to update the knowledge about major intraprocedural complications during TAVI, considering the increased operators' experience and recent device developments. An updated point of view on major intraprocedural complications could suggest a need for change in the TAVI paradigm, promoting TAVI programs even in centers without on-site cardiac surgery.