Timing of Noncardiac Surgery Following Transcatheter Aortic Valve Replacement: A National Analysis.

Ebrahimian S, Chervu N, Balian J, Mallick S, Yang EH, Ziaeian B, Aksoy O, Benharash P. Timing of Noncardiac Surgery Following Transcatheter Aortic Valve Replacement: A National Analysis. JACC. Cardiovascular interventions. 2024 Jun 13.

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Abstract:

BACKGROUND: The optimal timing of noncardiac surgery (NCS) following transcatheter aortic valve replacement (TAVR) for aortic stenosis has not been elucidated by current national guidelines. OBJECTIVES: The aim of this study was to evaluate the effect of the time interval between TAVR and NCS (?t) on the perioperative risk of major adverse events (MAEs). METHODS: All adult admissions for isolated TAVR for aortic stenosis were identified in the 2016 to 2020 Nationwide Readmissions Database. Patients who received NCS on subsequent admission were included for analysis and grouped by ?t as follows:  = 30, 31 to 60, 61 to 90, and > 90 days. Multivariable regression models were constructed to examine the association of ?t with ensuing outcomes. RESULTS: Of 3,098 patients (median age  =  79 years, 41.6% female), 19.1% underwent NCS at  = 30 days, 22.9% at 31 to 60 days, 16.7% at 61 to 90 days, and 41.3% at > 90 days. After adjustment, the odds of MAEs were similar for operations performed at  = 30 days (adjusted OR [AOR]: 1.05; 95% confidence interval [CI]: 0.74-1.50), 31 to 60 days (AOR: 0.97; 95% CI: 0.71-1.31), and 61 to 90 days (AOR: 0.95; 95% CI: 0.67-1.34), with those at > 90 days as reference. When examining the average marginal effect of the interval to surgery, risk-adjusted MAE rates were statistically similar across ?t groups for elective status and NCS risk category combinations. CONCLUSIONS: NCS within 30, 31 to 60, or 61 to 90 days after TAVR was not associated with increased odds of MAEs compared with operations after 90 days irrespective of NCS risk category or elective status. Our findings suggest that the interval between NCS and TAVR may not be an accurate predictor of MAE risk in this population.