Valvular & structural heart disease
Non-cardiac surgery after transcatheter aortic valve implantation
Authors' 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.
Study context
- Population
- Patients electively readmitted for non-cardiac surgery (NCS) within 6 months after discharge for transcatheter aortic valve implantation (TAVI)patients electively admitted for NCS within 6 months, out of 502,775 TAVI procedures
- Participants
- 2,390 participants
- Exposure
- Perioperative outcomes of NCS after TAVI according to the surgical risk as low, intermediate, and high
- Low-riskn = 321
- Intermediate-riskn = 1,522
- High-riskn = 547
- Outcome
- In-hospital major adverse events (MAE): composite of death, cardiac complications, and stroke/transient ischaemic attack
- Follow-up
- In-hospital
Methodological details2012–2021, multivariable regression models
- 2012–2021
- Multivariable regression models
Main finding
As reported in the abstract
Overall rate of post-operative major adverse events (MAE)
7.6%
n = 181
Observational data: associations, not effects.
Further findings
Incidence of elective NCS within 6 months after TAVI · within 6 months after discharge
Factors independently associated with the primary outcome
| aOR (CI) | P value | ||
|---|---|---|---|
| Congestive heart failure | 1.62 (1.23–2.12) | P < 0.001 | |
| Liver disease | 2.17 (1.37–3.45) | P = 0.001 | |
| Diabetes mellitus | 1.44 (1.13–1.82) | P = 0.003 | |
| Cancer | 1.18 (0.92–1.50) | P < 0.001 | |
| Anaemia | 0.76 (0.58–0.99) | P = 0.046 | |
| Time to readmission | 1.00 (0.99–1.00) | P = 0.004 | |
| 0.20.5125Adjusted odds ratio (log scale) |
| Outcome | Low-risk | Intermediate-risk | High-risk |
|---|---|---|---|
| Time from TAVI discharge to surgery | — not stated in the abstract | — not stated in the abstract | median 67 (IQR 41–109) days |
— not stated in the abstract
- Incidence of elective NCS within 6 months after TAVI — Patients electively admitted for NCS out of 502 775 TAVI procedures
- 2390 (0.48%)
- Time from TAVI discharge to surgery — Overall median
- 83 days (IQR 48-120)
- Time from TAVI discharge to surgery: significantly shorter for high-risk surgeries, P < 0.001
Components of the primary outcome
- Cardiac complications
- 3.6%
- Death
- 1.3%
- Death rates almost identical between surgical risk groups (P = 0.99)
Baseline characteristics
- Median age
- 78 years (IQR 73-84)
- Male
- 59%
Original publication
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