{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T14:11:05Z","timestamp":1767708665822,"version":"3.48.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T00:00:00Z","timestamp":1764806400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Intraprocedural complications of transcatheter aortic valve replacement (TAVR) continue to necessitate conversion to emergent open cardiac surgery. The need for on-site surgical backup remains debated. This study investigates the current incidence and outcomes of surgical conversions during TAVR in the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We queried the National Inpatient Sample Database to identify patients aged 18 and older who underwent percutaneous TAVR as the primary procedure between 2017 and 2021. Conversion was defined as any open cardiac surgery performed within 1 day following TAVR. We compared the characteristics and outcomes of patients with and without conversions and analysed trends in conversion incidence and in-hospital mortality, as well as predictors of conversion and post-conversion mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our analysis included 68\u2009141 TAVR patients, of whom 410 (0.6%) required conversion. The incidence of conversion increased from 0.50% to 0.68% (Ptrend\u2009=\u2009.045). Post-conversion mortality decreased from 30.0% to 17.9% (Ptrend\u2009=\u2009.006). The patients who underwent conversions were younger [73.9 (12.4) vs 78.5 (8.5), P\u2009&amp;lt;\u2009.001]. Risk factors for surgical conversion included liver disease [odds ratio (OR) 1.61, 95% confidence interval (CI) 1.12-2.31, P\u2009=\u2009.010], malnutrition (OR 3.15, 95% CI 1.91-5.17, P\u2009&amp;lt;\u2009.001), and rheumatic valve disease (OR 1.55, 95% CI 1.14-2.12, P\u2009=\u2009.006). Among converted cases, the incidence of cardiac bleeding and need for pericardiocentesis decreased from 40.0% to 24.8% (Ptrend\u2009=\u2009.016) and 32.0% to 20.5% (Ptrend\u2009=\u2009.015), respectively, while composite complications were constant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The incidence of surgical conversion increased and post-conversion mortality decreased in the contemporary era. The overall risk profile and severe intraprocedural cardiac injuries have decreased in the TAVR cohort.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaf435","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T13:16:44Z","timestamp":1764767804000},"source":"Crossref","is-referenced-by-count":0,"title":["Incidence and Outcomes of Surgical Bailout for Transcatheter Aortic Valve Replacement"],"prefix":"10.1093","volume":"68","author":[{"given":"Daniel","family":"McGrath","sequence":"first","affiliation":[{"name":"Department of Medicine, Tufts Medical Center , Boston, MA 02111,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charley","family":"Sun","sequence":"additional","affiliation":[{"name":"Tufts University School of Medicine , Boston, MA 02111,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Zhu","sequence":"additional","affiliation":[{"name":"Tufts University School of Medicine , Boston, MA 02111,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Warner","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Tufts Medical Center , Boston, MA 02111,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4769-3129","authenticated-orcid":false,"given":"Kanhua","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Missouri\u2014Kansas City School of Medicine , Kansas City, MO 64108,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4144-9915","authenticated-orcid":false,"given":"Yong","family":"Zhan","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center , Boston, MA 02111,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"key":"2026010609072880300_ezaf435-B1","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1056\/NEJMoa1514616","article-title":"Transcatheter or surgical aortic valve replacement in intermediate-risk patients","volume":"374","author":"Leon","year":"2016","journal-title":"N Engl J Med"},{"key":"2026010609072880300_ezaf435-B2","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1093\/ejcts\/ezy034","article-title":"Predictors and outcome of conversion to cardiac surgery during transcatheter aortic valve implantation","volume":"54","author":"Arsalan","year":"2018","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026010609072880300_ezaf435-B3","doi-asserted-by":"crossref","first-page":"ezaf276","DOI":"10.1093\/ejcts\/ezaf276","article-title":"2025 ESC\/EACTS guidelines for the management of valvular heart disease","volume":"67","author":"Praz","year":"2025","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026010609072880300_ezaf435-B4","first-page":"e72","article-title":"2020 ACC\/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American Heart Association joint committee on clinical practice guidelines","volume":"143","author":"Otto","year":"2021","journal-title":". Circulation."},{"key":"2026010609072880300_ezaf435-B5","doi-asserted-by":"crossref","first-page":"e013080","DOI":"10.1161\/CIRCINTERVENTIONS.123.013080","article-title":"Mediators of improvement in TAVR outcomes over time: insights from the STS-ACC TVT Registry","volume":"16","author":"Arnold","year":"2023","journal-title":"Circ Cardiovasc Interv"},{"key":"2026010609072880300_ezaf435-B6","doi-asserted-by":"crossref","first-page":"2168","DOI":"10.1016\/j.jcin.2018.09.013","article-title":"Transcatheter aortic valve replacement without on-site cardiac surgery: a disappointing step backward!","volume":"11","author":"Mack","year":"2018","journal-title":"JACC Cardiovasc Interv"},{"key":"2026010609072880300_ezaf435-B7","doi-asserted-by":"crossref","first-page":"3031","DOI":"10.1016\/j.jcin.2023.10.038","article-title":"Transcatheter aortic valve replacement without onsite cardiac surgery: a simplified or simplistic approach?","volume":"16","author":"Urena","year":"2023","journal-title":"JACC 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