Cardiac Surgery After Transcatheter Aortic Valve Replacement: Trends and Outcomes

This report presents trends and outcomes of cardiac surgery following initial transcatheter aortic valve replacement (TAVR). The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database was queried for all adult patients undergoing cardiac surgery after a previously placed TAVR between January 2012 and March 2023. A total of 5457 patients were identified, of which 2972 (54.5 percent) underwent SAVR (surgical aortic valve replacement), and 2485 (45.5 percent) underwent non-SAVR cardiac surgery. The frequency of cardiac surgery after TAVR increased by 4235.3 percent overall and 144.6 percent per year throughout the study period. The incidence of operative mortality and stroke were 15.5 percent and 4.5 percent, respectively. The observed to expected mortality ratios based on the STS risk score were significantly greater than 1.0, demonstrating a poor performance of the existing STS risk estimation models.