Non-cardiac surgery after transcatheter aortic valve implantation

Abstract

Aims: There is a lack of data on perioperative outcomes for patients undergoing non-cardiac surgery (NCS) after transcatheter aortic valve implantation (TAVI). Hence, we aimed to determine the incidence, type of surgery, timing, and perioperative outcomes of individuals undergoing elective NCS after discharge for TAVI.

Methods and results: Hospitalisations for TAVI were identified from the US National Readmission Database between 2012 and 2021, and patients who received NCS within 6 months were included for analysis. Incidence, type, and timing of planned readmissions for NCS were evaluated according to the surgical risk as low, intermediate, and high. The primary outcome was the occurrence of in-hospital major adverse events (MAE), defined as the composite of death, cardiac complications, and stroke/transient ischaemic attack. Multivariable regression models were constructed to identify independent factors associated with MAE. Out of 502 775 TAVI procedures, 2390 (0.48%) patients were electively admitted to undergo NCS within 6 months after discharge for TAVI. Surgeries were classified as low- (n = 321, 13.4%), intermediate- (n = 1522, 63.7%), and high-risk (n = 547, 22.9%). The median age of the study population was 78 years (IQR 73-84), with 59% of participants being male. Overall surgeries occurred at a median of 83 days (IQR 48-120) after discharge for TAVI, a time-period which was significantly shorter for those who underwent high-risk surgeries (median 67, IQR 41-109 days, P < 0.001). The overall rate of post-operative MAE was 7.6% (n = 181), and these rates did not differ between surgical risk groups (P = 0.46). The primary outcome was driven primarily by cardiac complications (3.6%), while rates of death were low (1.3%) and almost identical between surgical risk groups (P = 0.99). Factors independently associated with the primary outcome were congestive heart failure (aOR: 1.62, CI: 1.23-2.12, P < 0.001), liver disease (aOR: 2.17, CI: 1.37-3.45, P = 0.001), diabetes mellitus (aOR: 1.44, CI: 1.13-1.82, P = 0.003), cancer (aOR: 1.18, CI: 0.92-1.50, P < 0.001), anaemia (aOR: 0.76, CI: 0.58-0.99, P = 0.046), and time to readmission (aOR: 1.00, CI: 0.99-1.00, P = 0.004).

Conclusion: Elective NCS occurred infrequently post-TAVI and was associated with low rates of mortality. While diabetes mellitus, congestive heart failure, liver disease, cancer, anaemia, and time to readmission were associated with post-procedural adverse events, the surgical risk was not. The risk of NCS after TAVI should be balanced against the risk of delaying an operation.

Keywords: TAVI; aortic stenosis; non-cardiac; surgery.