Influence of Transcatheter Aortic Valve Replacement on Patients with Severe Aortic Stenosis Undergoing Non-Cardiac Surgery

Objectives: The purpose of this study was to clarify the influence of transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis (AS) undergoing non-cardiac surgery.Methods: Thirty-four patients with severe AS diagnosed by preoperative evaluation for non-cardiac surgery were reviewed and compared in two categories. First, patient profiles and surgical risk were compared before (pre-TAVR group; n=10) and after (post-TAVR group; n=24) the introduction of TAVR. Second, the completion rate of non-cardiac surgery and interval between the two cardiac and non-cardiac operations were compared between surgical aortic valve replacement (AVR) patients before the introduction of TAVR (pre-AVR group (n=10)), in AVR patients after the introduction of TAVR (post-AVR (n=12)), and in TAVR patients (TAVR group (n=12)).Results: Age and Japan score were higher in the post-TAVR group than in the pre-TAVR group. Malignancy was the most common non-cardiac disease (80%) in the pre-TAVR group, whereas orthopedic disease was the most common (50%) in the post-TAVR group. Completion rate of non-cardiac operation in the pre-AVR, post-AVR and TAVR groups was 70%, 33%, and 75% (post-AVR vs. TAVR: p=0.010), and the interval between the two operations was 129±98 days, 87±40 days and 27±15 days, respectively (pre AVR vs. TAVR: p=0.034 and post AVR vs. TAVR: p=0.025). In the post-TAVR group, AVR was selected because of a lack of fitness for TAVR in 5 of 12 patients.Conclusions: After the introduction of TAVR, more senile and high-risk patients became candidates for a two-stage operation, and orthopedic conditions became the most common non-cardiac disease. Innovation in transcatheter valvular interventions and expansion of indications for patients currently evaluated as “unfit for TAVR” might be crucial issues for non-cardiac surgery with severe AS.