When to Perform Non-Cardiac Surgery After TAVR

Transcatheter aortic valve replacement (TAVR) is becoming increasingly common, not only in high-risk or inoperable patients but also in those with lower risk. However, many cases often require non-cardiac surgery (NCS) after the procedure.

The optimal timing for such a surgery is currently unclear. While the usual recommendation is waiting between one and three months after TAVR, there is no clear evidence on the most appropriate timing or how long should the surgery be delayed based on the type of NCS.

Researchers conducted an analysis on 212,855 patients who underwent TAVR, of whom 3098 (1.4%) required NCS. Patients were divided into four groups according to the time elapsed between TAVR and NCS: ≤30 days (593 patients), 31-60 days (710 patients), 61-90 days (518 patients), and >90 days (1277 patients).

The groups were similar in terms of age (average of 78 years), female predominance, and comorbidities. Patients who underwent NCS after 90 days were lower risk compared to the other groups.

Carotid endarterectomy was the most frequent surgery in the 31-60 days and 61-90 days groups, while colectomy and hip surgery were the most common among those who underwent NCS within 30 days or after 90 days.

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There was no increase in major cardiovascular events among the different groups: 37.9% (95% confidence interval [CI]: 32.5%-43.4%) in the ≤30 days group, 36.4% (95% CI: 32.0%-40.8%) in the 31-60 days group, 36.0% (95% CI: 30.4%-41.6%) in the 61-90 days group, and 37.0% (95% CI: 33.5%-40.6%) in the >90 days group. The length of hospitalization stay after NCS was similar across all groups. However, higher-risk surgeries were associated with an increased risk, and those conducted within 30 days featured a higher risk for bleeding.

Conclusion

Performing non-cardiac surgery after TAVR, whether within the first 30 days, between 31 and 60 days, or between 61 and 90 days, was not associated with a significant increase in the likelihood of major adverse events compared with patients who underwent NCS after 90 days, regardless of the risk posed by the non-cardiac surgery or whether it was elective. These findings suggest that the interval between TAVR and non-cardiac surgery is not an important predictor of major adverse risks in this population.

Original Title: Timing of Noncardiac Surgery Following Transcatheter Aortic Valve Replacement A National Analysis.

Reference: Shayan Ebrahimian, et al. JACC Cardiovasc Interv 2024;17:1693–1704).