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.

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.

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