High Mortality Rates for Redo Surgery After TAVR

Courtesy of Dr. Carlos Fava.

Since the beginnings of transcatheter aortic valve replacement (TAVR) back in 2002, this strategy has gained considerable ground, encompassing not only inoperable or high-risk patients but also those at medium and low risk. Additionally, it came to include patients with failed bioprostheses.

Incidencia, características y tratamiento de la trombosis valvular post TAVI

However, there is little information on patients who require valve surgery after TAVR (something that is extremely rare).

Researchers analyzed 123 patients from the Society of Thoracic Surgeons (STS) database who required surgical aortic valve replacement after TAVR. Procedures had been conducted between 2011 and 2015.

Mean patient age was 84 years old, and 38% of subjects were female.

Patients were classified according to their STS Predicted Risk of Mortality score. In total, 17% of subjects had an STS score <4%; 24% had a score between 4% and 8%, and the remaining 59% of subjects had a score >8%.

The most common reason for surgery was paravalvular leak, followed by structural prosthetic deterioration, device sizing/position issues, and endocarditis.


Read also: SURTAVI Follow-Up Completed with Good News.


The median time between TAVR and redo surgery was 2.5 months (0.7-13).

Surgical mortality at 30 days was 17.1%. The mortality rate for low-risk patients was 14%; for medium-risk patients, 10%, and for high-risk patients, 21%.

Mortality was higher for patients with endocarditis (25%) and with leak or device sizing/position issues (24%), compared with patients with structural prosthetic deterioration (15%).

Conclusion

Surgery after TAVR failure, which is rare, is associated with a worse-than-expected prognosis compared with similar patients initially undergoing surgery. Technology development is needed to reduce the incidence of early TAVR failure and to define optimal treatment in case of failed TAVR.

Courtesy of Dr. Carlos Fava.

Original title: Reoperation After Transcatheter Aortic Valve Replacement An Analysis of the Society of Thoracic Surgeons Database.

Reference: Oliver K. Jawitz, et al. J Am Coll Cardiol Intv 2020;13:1515-1525.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...

TAVR in Young Low-Risk Patients

Transcatheter aortic valve replacement (TAVR) has established itself as an effective strategy for the treatment of severe aortic stenosis across different risk groups. While previous...

TAVR and Atrial Fibrillation: What Anticoagulants Should We Use?

The prevalence of atrial fibrillation (AF) in TAVR patients ranges from 15 to 30%, depending on series. This arrhythmia has been associated to higher...

Impact of Iliofemoral Disease on Post TAVR Clinical Outcomes: HOSTILE Score Validation

At present, transcatheter aortic valve replacement (TAVR) has been shown safe and effective for treating severe symptomatic aortic stenosis in high-surgical-risk patients. Moreover, its...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...