TAVR Surgery Recipients Face Greater Risks from Later Heart Surgeries: Study

Researchers warn about a potential looming TAVR removal pandemic in the future, amid concerns that the valves are deteriorating prematurely.

Patients who need heart surgery after undergoing aortic valve replacement face an increased risk of serious side effects and a greater risk of death, according to the findings of a new study, which also warns of a potential TAVR removal pandemic in the future that may result from structural deterioration of the valves over time.

Dr. Michael Bowdish, of Cedars-Sinai Medical Center in Los Angeles told attendees at a meeting of the Society of Thoracic Surgeons that patients who underwent transcatheter aortic valve replacement (TAVR) and needed cardiac surgery later on often faced complication requiring yet another surgery later. They also required the valve replacement to be completely removed, and faced an increased risk of death.

TAVR is a procedure where the heart valve is replaced by threading it through an artery in the leg instead of via open chest surgery. It places the valve directly over the damaged aortic valve in a less invasive procedure, which is why it is often favored by doctors.

Data indicates the number of valve removals increased after the TAVR procedure was approved as low risk in 2019. However, surgeons warn this type of surgery carries serious risks, especially if the patient must undergo additional heart surgery later on. Aortic valve procedures are common after undergoing TAVR, Bowdish indicated.

Post-Surgical TAVR Heart Risks

According to Bowdish, researchers examined data from the STS Adult Cardiac Surgery database from 2012 through March 2023. The information focused on 5,400 patients who had gone through heart valve replacement surgery.

The patients were divided into two groups. The first group included 2,485 patients who underwent non-aortic valve replacement (non-AVR) surgery. The second included 2,972 patients in the surgical aortic valve replacement (SAVR) group.

The data indicates the risk of death was 16% after any TAVR surgery, and the risk of permanent stroke was 6%.

Bowdish said the data showed there were 60% more deaths after TAVR than predicted for a coronary artery bypass grafting (CABG) procedure. In addition, there were over 200% more deaths than expected after TAVR patients underwent mitral valve replacement.

Undergoing the second heart surgery or procedure greatly increased a TAVR patient’s risk of suffering side effects and death, the researchers concluded.

Patients who most likely needed a SAVR procedure after TAVR surgery included those who underwent emergency surgery, dialysis, CABG, mitral valve surgery, and aorta or root replacement. The most common non-aortic valve replacement procedures were CABG and mitral replacement surgery.

Undergoing SAVR or other aortic surgery after TAVR should not be considered simple or low risk, researchers indicated. And some factors may play a role in leading to the aortic valve implant being removed, including coronary obstructions, endocarditis, and other heart conditions.

TAVR Surgery Concerns

The researchers warn that they believe a TAVR removal pandemic is on the horizon, since many patients who underwent TAVR and other cardiac procedures may experience structural deterioration of the valve and need to have everything later removed.

Prior research has indicated that TAVR heart valves have an increased risk of rapid deterioration and pose a heightened risk of end-stage kidney disease. The deterioration required reintervention for many patients, often requiring them to undergo additional heart surgery procedures.

Other studies have linked TAVR surgery to an increased risk of endocarditis, a serious inflammation of the lining of the heart and heart valves, Patients undergoing TAVR surgery faced nearly double the risk of death, the data indicated.

The findings of this latest study are considered preliminary until published in a peer-reviewed journal.