Tracking the long-term safety of performing SAVR, other heart surgeries after TAVR
When patients undergo transcatheter aortic valve replacement (TAVR) and then require cardiac surgery later in life, surgical aortic valve replacement (SAVR) is associated with long-term outcomes comparable to other open heart surgeries. That is according to a new analysis in The American Journal of Cardiology from a team of Cleveland Clinic specialists.[1]
“Prior registry-based studies suggest that patients undergoing SAVR after prior TAVR may experience higher operative mortality compared to those undergoing redo SAVR after prior surgical prosthesis,” wrote senior author Samir Kapadia, MD, chair of the department of cardiovascular medicine at Cleveland Clinic, and colleagues. “The perceived complexity and risks of explanting TAVR valves have raised concerns, particularly regarding long-term outcomes. However, it remains unclear to what extent this risk reflects the complexity of TAVR explant itself versus the underlying patient comorbidities and cardiac surgery. Given the projected increase in TAVR utilization and subsequent need for reintervention, clarifying these long-term outcomes is critical for patient counseling, surgical planning, and shared decision-making in the heart team setting.”
The researchers used propensity-score matching to identify 132 patients who underwent SAVR after TAVR and a comparable group of 132 patients who underwent a non-SAVR open heart surgery after TAVR. The non-SAVR open heart surgery group included patients who underwent a variety of procedures, including coronary artery bypass grafting, mitral valve surgery, tricuspid valve surgery and septal repairs.
All patients received treatment from 2010 to 2023. All data came from the TriNetX global research network.
After five years, the all-cause mortality rates were 20.5% for the SAVR group and 24.2% for the open heart surgery group. Kaplan-Meier survival curves confirmed there was not a significant difference between the two groups in terms of long-term survival.
In addition, five-year rates of secondary outcomes such as acute coronary syndrome, stroke, heart failure hospitalization, major bleeding events and new-onset atrial fibrillation were similar for the two groups.
“This aligns with the growing understanding that while surgical explantation may be technically demanding, the elevated risk reported in the literature may also reflect the underlying complexity of the patient rather than the procedure itself,” the authors wrote.
The group also emphasized that more and more TAVR patients are going to require cardiac surgery later in life as time goes on. With this in mind, additional research is still needed to learn even more about the impact TAVR explant may have on long-term patient outcomes.
Click here to read the full study.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.