Key result
Non-emergent cardiac surgery post-TAVR is associated with ~7% operative mortality.
Why the study?
As TAVR volumes increase and expand to younger, lower-risk populations, understanding the nature and outcomes of subsequent cardiac operations is critical.
Cohort (n=61)
No
Non-emergent cardiac surgery after TAVR can be performed with acceptable operative mortality (6.6%), though long-term survival is limited (50% at 5 years), emphasizing the need to address non-aortic pathologies during initial TAVR planning.
Answers are grounded in this paper and cite their sources.
Non-emergent post-TAVR cardiac surgery may be feasible in select patients; leaves open optimal selection, timing, and long-term management.
OBJECTIVES: This study examined the indications, frequency, and outcomes of cardiac surgery following transcatheter aortic valve replacement (TAVR) at a single institution. As TAVR volumes increase, understanding the nature and outcomes of subsequent cardiac operations is critical, particularly as the procedure expands to younger, lower-risk populations. METHODS: We analyzed outcomes of 61 patients who underwent cardiac surgery after TAVR at our institution from August 2011 to September 2023, excluding periprocedural complications and staged procedures. Patients were stratified into two groups: those requiring surgical aortic valve replacement (SAVR) with or without concomitant procedures (n = 33) and those undergoing non-SAVR cardiac operations (n = 28). Data were collected from a prospectively maintained cardiovascular surgery database and electronic health records. Indications for surgery, operative characteristics, and outcomes were analyzed, with survival assessed using Kaplan-Meier estimates. RESULTS: The median interval between TAVR and cardiac surgery was 19 months. Indications for SAVR included infective endocarditis (36%), nonstructural valve deterioration (36%), structural valve deterioration (12%), and valve thrombosis (6%). Non-SAVR operations primarily addressed mitral valve disease (43%) and coronary artery disease (29%). Operative mortality was 6.6%, with no deaths in the endocarditis subgroup. Postoperative complications included prolonged mechanical ventilation (18%), new-onset renal failure (7%), and stroke (2%). Kaplan-Meier survival estimates were 83% at 1 year and 50% at 5 years. CONCLUSIONS: Although complex, cardiac operations in patients who have undergone TAVR can be performed with acceptable mortality rates. Structural valve deterioration, paravalvular leak, and endocarditis were the primary indications for SAVR, while mitral valve and coronary artery disease predominated in non-SAVR cases. These findings highlight the importance of considering nonaortic valve pathologies in TAVR planning, particularly as the procedure expands to younger, lower-risk populations.
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Qamar et al. (2026) conducted a cohort in Cardiac surgery following transcatheter aortic valve replacement (TAVR) (n=61). Cardiac surgery following TAVR was evaluated on Operative mortality. Non-emergent cardiac surgery following TAVR was associated with an operative mortality of 6.6% and Kaplan-Meier survival estimates of 83% at 1 year and 50% at 5 years.
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