Risk and Timing of Noncardiac Surgery After Transcatheter Aortic Valve Implantation.

Okuno, Taishi; Demirel, Caglayan; Tomii, Daijiro; Erdoes, Gabor; Heg, Dik; Lanz, Jonas; Praz, Fabien; Zbinden, Rainer; Reineke, David; Räber, Lorenz; Stortecky, Stefan; Windecker, Stephan; Pilgrim, Thomas (2022). Risk and Timing of Noncardiac Surgery After Transcatheter Aortic Valve Implantation. JAMA Network Open, 5(7), e2220689. American Medical Association 10.1001/jamanetworkopen.2022.20689

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Importance

Noncardiac surgery after transcatheter aortic valve implantation (TAVI) is a clinical challenge with concerns about safety and optimal management.

Objectives

To evaluate perioperative risk of adverse events associated with noncardiac surgery after TAVI by timing of surgery, type of surgery, and TAVI valve performance.

Design, Setting, and Participants

This cohort study was conducted using data from a prospective TAVI registry of patients at the tertiary care University Hospital in Bern, Switzerland. All patients undergoing noncardiac surgery after TAVI were identified. Data were analyzed from November through December 2021.

Exposures

Timing, clinical urgency, and risk category of noncardiac surgery were assessed among patients who had undergone TAVI and subsequent noncardiac surgery.

Main Outcomes and Measures

A composite of death, stroke, myocardial infarction, and major or life-threatening bleeding within 30 days after noncardiac surgery.

Results

Among 2238 patients undergoing TAVI between 2013 and 2020, 300 patients (mean [SD] age, 81.8 [6.6] years; 144 [48.0%] women) underwent elective (160 patients) or urgent (140 patients) noncardiac surgery after TAVI and were included in the analysis. Of these individuals, 63 patients (21.0%) had noncardiac surgery within 30 days of TAVI. Procedures were categorized into low-risk (21 patients), intermediate-risk (190 patients), and high-risk (89 patients) surgery. Composite end points occurred within 30 days of surgery among 58 patients (Kaplan-Meier estimate, 19.7%; 95% CI, 15.6%-24.7%). There were no significant differences in baseline demographics between patients with the 30-day composite end point and 242 patients without this end point, including mean (SD) age (81.3 [7.1] years vs 81.9 [6.5] years; P = .28) and sex (25 [43.1%] women vs 119 [49.2%] women; P = .37). Timing (ie, ≤30 days from TAVI to noncardiac surgery), urgency, and risk category of surgery were not associated with increased risk of the end point. Moderate or severe prosthesis-patient mismatch (adjusted hazard ratio [aHR], 2.33; 95% CI, 1.37-3.95; P = .002) and moderate or severe paravalvular regurgitation (aHR, 3.61; 95% CI 1.25-10.41; P = .02) were independently associated with increased risk of the end point.

Conclusions and Relevance

These findings suggest that noncardiac surgery may be performed early after successful TAVI. Suboptimal device performance, such as prosthesis-patient mismatch and paravalvular regurgitation, was associated with increased risk of adverse outcomes after noncardiac surgery.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Okuno, Taishi; Demirel, Caglayan; Tomii, Daijiro; Erdoes, Gabor; Heg, Dierik Hans; Lanz, Jonas; Praz, Fabien Daniel; Zbinden, Rainer; Reineke, David Christian; Räber, Lorenz; Stortecky, Stefan; Windecker, Stephan and Pilgrim, Thomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2574-3805

Publisher:

American Medical Association

Language:

English

Submitter:

Pubmed Import

Date Deposited:

08 Jul 2022 10:44

Last Modified:

13 Jul 2022 11:01

Publisher DOI:

10.1001/jamanetworkopen.2022.20689

PubMed ID:

35797045

Additional Information:

Okuno and Demirel contributed equally to this work.

BORIS DOI:

10.48350/171185

URI:

https://boris.unibe.ch/id/eprint/171185

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