Patients can safely undergo noncardiac surgeries after TAVR without a long delay

A new study of 300 patients who underwent noncardiac surgery after successful transcatheter aortic valve replacement (TAVR) found no increase in the risk of adverse events surrounding the operation. The analysis, focused on both elective and urgent noncardiac procedures, was published in full in JAMA Network Open.[1] 

However, the study’s authors did find that patients who do experience adverse events—including death, stroke, myocardial infarction, or major or life-threatening bleeding within 30 days after surgery—were more likely to have had suboptimal TAVR outcomes, such as prosthesis-patient mismatch or paravalvular leakage.  

“These findings suggest that noncardiac surgery may be performed early after successful TAVR,” wrote first author Taishi Okuno, MD, a cardiologist with the University of Bern, and colleagues

To make the determination, the study’s authors reviewed medical records for 300 patients that underwent TAVR at Bern University Hospital in Switzerland between 2013 and 2020, followed by noncardiac surgery. The average patient age was 81.8 years, and 58 patients experienced adverse events within 30 days of noncardiac surgery after TAVR. 

Those with prosthesis-patient mismatch were 2.33 times as likely to experience adverse outcomes within 30 days, while those with paravalvular leakage were 3.61 times more likely to experience adverse outcomes within 30 days. 

The study also examined whether adverse outcomes were more or less likely depending on variables including time between TAVR and noncardiac surgery and risk category of noncardiac surgery, but found no significant associations between these variables and adverse outcomes. 

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1. Okuno T, Demirel C, Tomii D, et al. Risk and Timing of Noncardiac Surgery After Transcatheter Aortic Valve Implantation. JAMA Netw Open. 2022;5(7):e2220689. doi:10.1001/jamanetworkopen.2022.20689

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