Initial experience with transcatheter aortic valve replacement before and after lung transplant

Patients with end-stage lung disease and lung transplant (LTx) recipients are high-risk candidates for surgical aortic valve replacement (AVR). Transcatheter AVR (TAVR) is an established treatment for aortic stenosis. Experience with TAVR in the LTx population is limited. We sought to report our experience in patients who underwent TAVR before or after LTx.

Single-center, retrospective analysis, including all patients who underwent TAVR pre- or post-LTx from 2000 to 2020. Indications, mode of anesthesia, timing of TAVR, and procedural outcomes were reviewed.

In total, 10 LTx patients underwent TAVR. Aortic stenosis was the indication for TAVR in all patients: 5 had TAVR pre-LTx, and 5 post-LTx. All 10 TAVRs were performed with transfemoral access, and 9 out of 10 with intravenous sedation and monitored anesthesia care; only 1 required general anesthesia. In the TAVR pre-LTx group, mean age was 62 years and 4 patients were men. Four TAVR valves were balloon-expandable and 1 self-expanding. Median time from TAVR to transplant was 7.4 months (range, 1.7-36 months), and median length of stay after TAVR 4 days (range, 2-36 days). The only TAVR-related complication was a pacemaker for heart block (1 out of 5). All 5 subsequently underwent successful double LTx (1 with concurrent liver transplant). In the TAVR post-LTx group, mean age was 66 years and 2 patients were men. Four TAVR valves were balloon-expandable and 1 was self-expanding. Median time from LTx to TAVR was 5 years (range, 2.6-7.6 years), and median length of stay post-TAVR was 2 days (range, 1-17 days). The only TAVR-related complication in this group was heart block requiring pacemaker (1 out of 5). In both groups, there were no intraprocedural mortalities or conversions to surgical AVR. No patients required post-TAVR surgical intervention during study follow-up.

Our initial experience suggests that TAVR is safe and feasible for treatment of aortic stenosis in patients with end-stage lung disease awaiting LTx, and in patients who have undergone LTx. Overall TAVR-related complications included need for pacemaker. TAVR should be considered for treatment of aortic stenosis in patients with end-stage lung disease awaiting transplant, and for post-LTx patients as an alternative to surgical aortic valve replacement.