Mitral valve surgery post-transcatheter aortic valve replacement: A 10-year, single-center, retrospective analysis

Cardiac operations after transcatheter aortic valve replacement (TAVR) are complex procedures with high morbidity and mortality. We sought to determine the outcomes of mitral valve surgery in patients with previous TAVR.

Among 2339 patients who underwent mitral valve surgery at our institution between July 2014 and July 2024, a retrospective, descriptive analysis was performed on 19 consecutive patients with a history of TAVR requiring mitral valve surgery.

Mean age was 73.1 ± 9.5 years. The median (interquartile range) time since TAVR was 1 year (1, 3). The indication for mitral valve surgery was active infective endocarditis in 4 patients (21%), and degenerative disease in the remaining. The average Society of Thoracic Surgeons predicted risk of mortality was 12.0 ± 9.3%, with 6 (31.6%) urgent and 2 (10.5%) emergent operations. Nine patients (47.3%) had history of previous cardiac surgery. Mitral valve repair was performed in 1 patient, whereas replacement with a bioprosthetic valve in all other cases. Transcatheter valve explant was necessary in 10 operations (52.6%), and 13 patients had a concomitant procedure. The primary end point of all-cause mortality at 30 days was met in 5 patients (26.3%), 3 of whom underwent TAVR explant. One patient (5.3%) suffered a stroke. Median crossclamp and cardiopulmonary bypass times were 144 (106, 189) and 214 (155, 253) minutes, respectively. Postoperative dialysis was required in 4 (21.1%). One patient required a reintervention and 3 were re-hospitalized after discharge.

Mitral valve surgery in the presence of TAVR is uncommon but carries a high risk of mortality and morbidity.