The STS Risk Model for SAVR After TAVR

This study developed and validated an updated Society of Thoracic Surgeons (STS) risk model for surgical aortic valve replacement after a failed transcatheter aortic valve replacement (SAVR-after-TAVR), including the emergent and concomitant-procedure cases that earlier isolated models omitted. Using the STS Adult Cardiac Surgery Database from July 2014 to March 2025, the authors identified 5,708 SAVR-after-TAVR cases among 651,398 SAVR patients; 40.3 percent were isolated and 59.7 percent involved concomitant procedures, representing a volume that increased more than twelvefold over the decade. De novo models for all eight STS endpoints showed excellent discrimination, with a C-statistic of 0.82 for operative mortality, plus strong calibration across subgroups. Overall, operative mortality was 14.4 percent, declining from 21.5 percent to 12.4 percent across the study period. Among isolated cases potentially eligible for valve-in-valve TAVR, it dropped to 3.5 percent, with most patients qualifying as low risk. The model supports Heart Team decision-making for this growing population.