A Decade of Cardiac Surgery After Transcatheter Aortic Valve Replacement: Short-Term Clinical Outcomes at a High-Volume Center

This single-center retrospective study evaluated 61 patients who underwent cardiac surgery after prior transcatheter aortic valve replacement (TAVR) during a 10-year period at a high-volume academic center. Cardiac surgery following TAVR was uncommon, accounting for only 0.5 percent of all cardiac operations, but was associated with substantial morbidity and mortality. The most common indications were transcatheter valve dysfunction (28 percent) and infective endocarditis (26 percent), with TAVR explantation and surgical aortic valve replacement performed in 80 percent of cases. Thirty-day mortality was 13 percent, stroke occurred in 3 percent, prolonged ventilation occurred in 31 percent, and 34 percent of patients required discharge to a rehabilitation facility. Patients undergoing TAVR explant experienced significantly longer cardiopulmonary bypass and cross-clamp times. The authors conclude that post-TAVR cardiac surgery remains a highly complex and high-risk intervention, highlighting the importance of lifetime management strategies, careful patient selection, and multidisciplinary heart team planning when considering initial valve therapy.