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 introduction of transcatheter aortic valve replacement (TAVR)on 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 following two categories. First,patient’s profile and surgical risk were compared between pre-TAVR group (n=10) and post-TAVR group (n=24)according to before or after the introduction of TAVR. Second, completion rate of non-cardiac surgery and interval between two operation were compared between surgical aortic valve replacement(AVR)patients before introduction of TAVR (pre-AVR group (n=10)), AVR patientsafter introduction of TAVR (post-AVR (n=12)), and TAVR patients (TAVR group (n=12)). Results: Ageand Japan score were higherin post-TAVR group than in pre-TAVR group. Malignancy was the most common non-cardiac disease (80%) in pre-TAVR group, however, orthopedic disease became the most common (50%) in post-TAVR group. Completion rate of non-cardiac operation in pre-AVR, post-AVR and TAVR group were 70%, 33%, and 75% (post-AVR vs. TAVR: p=0.010), and interval between two operations were 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 Post-TAVR group, AVR was selected because of unfit condition for TAVR in 5 out of 12 patients. Conclusions: After introduction of TAVR, more senile and high-risk patients became the candidate for two staged operation and orthopedics became the most common non-cardiac disease. Innovation of transcatheter valvular interventionsand expansion of indication for currently evaluated as “unfit for TAVR” might be crucial issue for non-cardiac surgery with severe AS.