{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T22:42:38Z","timestamp":1790289758607,"version":"4.1.0"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Emergent conversion to open heart surgery (E-OHS) during transcatheter aortic valve implantation (TAVI) is rare (0.5%\u20132%) but carries high perioperative mortality. Long-term outcomes in survivors beyond 30\u2005days are not well defined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To assess 1-year conditional outcomes in patients who survived \u226530\u2005days post-TAVI, comparing E-OHS survivors with propensity-matched uncomplicated TAVI recipients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between January 2020 and August 2023, 825 consecutive TAVI procedures were performed at three Italian centers; 11 patients (1.3%) required E-OHS for catastrophic intraprocedural complications. A 30-day landmark analysis excluded early deaths (E-OHS: <jats:italic>n<\/jats:italic>\u2009=\u20093; controls: <jats:italic>n<\/jats:italic>\u2009=\u200925). Propensity matching (1:10) was performed on nine variables, yielding 8 E-OHS survivors and 80 well-matched controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Primary endpoint<\/jats:title><jats:p>All-cause mortality from day 31 to 1\u2005year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Secondary endpoints<\/jats:title><jats:p>Composite of death, moderate-or-greater paravalvular regurgitation, or valve reintervention; heart failure rehospitalization; permanent pacemaker; stroke\/transient ischemic attack (TIA); and acute kidney injury (AKI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Baseline characteristics were comparable. The mean age was 77\u2009\u00b1\u20095\u2005years; EuroSCORE II was 6.8\u2009\u00b1\u20092.1%. One-year conditional mortality was 0% in E-OHS survivors vs. 2.9% in controls (<jats:italic>p<\/jats:italic>\u2009=\u20090.64). The composite endpoint occurred in 12.5% vs. 13.6% (<jats:italic>p<\/jats:italic>\u2009=\u20090.88). Other outcomes were similar: heart failure rehospitalization (12.5% vs. 11.2%), pacemaker implantation (12.5% vs. 9.6%), stroke\/TIA (0% vs. 1.2%), and AKI (0% vs. 7.2%). No structural valve deterioration or thrombosis was observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>E-OHS survivors who overcome the initial high-risk phase achieve 1-year outcomes comparable to standard TAVI patients. These findings support immediate surgical backup within TAVI programs and provide reassurance for high-risk patient counseling.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1660381","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T05:30:22Z","timestamp":1758173422000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Conditional 1-year outcomes after emergent conversion to open heart surgery during transcatheter aortic valve implantation: a propensity-matched landmark 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