Redo Surgical Aortic Valve Replacement After Prior Transcatheter Versus Surgical Aortic Valve Replacement

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Heart Valve Disease

Background:

• Lifetime management of aortic stenosis requires careful consideration of risks and benefits for treatment options.
• Concerns are growing regarding the safety and feasibility of reoperation after transcatheter aortic valve replacement (TAVR).

Purpose of the Study:

• To compare the risk of surgical aortic valve replacement (SAVR) in patients with prior TAVR versus those with prior SAVR.
• To evaluate operative mortality associated with redo SAVR after TAVR.

Main Methods:

• Analysis of data from the Society of Thoracic Surgeons Database (2011-2021) for patients undergoing bioprosthetic SAVR.
• Inclusion of patients with prior TAVR (TAVR-SAVR), prior SAVR and TAVR (SAVR-TAVR-SAVR), and prior SAVR (SAVR-SAVR).
• Risk adjustment using logistic regression and propensity score matching for isolated SAVR cases, with operative mortality as the primary outcome.

Main Results:

• The TAVR-SAVR cohort was older, had higher acuity, and more comorbidities.
• Unadjusted operative mortality was highest in the TAVR-SAVR group (17%).
• Risk-adjusted analysis showed significantly higher operative mortality for TAVR-SAVR compared to SAVR-SAVR (OR: 1.53; P=0.004), with no significant difference for SAVR-TAVR-SAVR.

Conclusions:

• The number of reoperations after TAVR is increasing, representing a high-risk patient group.
• SAVR following TAVR is independently linked to a higher risk of operative mortality, even in isolated SAVR cases.
• A SAVR-first strategy may be advisable for patients with a life expectancy exceeding TAVR valve durability and unsuitable anatomy for repeat TAVR.