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Timing of Noncardiac Surgery Following TAVR
Quick Takes
- The important take-home message of this study is that the timing between TAVR and noncardiac surgery (NCS) does not affect the outcome of NCS.
- The risk of NCS depends on the risk and urgency of NCS but not on the time interval between TAVR and NCS.
Study Questions:
What is the effect of the time interval between transcatheter aortic valve replacement (TAVR) and noncardiac surgery (NCS) (Δt) on the perioperative risk of major adverse events (MAEs)?
Methods:
The investigators identified all adult admissions for isolated TAVR for aortic stenosis in the 2016–2020 Nationwide Readmissions Database. Patients who received NCS on subsequent admission were included for analysis and grouped by Δt as follows: ≤30, 31-60, 61-90, and >90 days. Multivariable regression models were constructed to examine the association of Δt 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 31-60 days, 16.7% at 61-90 days, and 41.3% at >90 days. After adjustment, the odds of MAEs were similar for operations performed at ≤30 days (adjusted odds ratio [aOR], 1.05; 95% confidence interval [CI], 0.74-1.50), 31-60 days (aOR, 0.97; 95% CI, 0.71-1.31), and 61-90 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 Δt groups for elective status and NCS risk category combinations.
Conclusions:
The authors report that NCS within 30, 31-60, or 61-90 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.
Perspective:
This study reports similar risk-adjusted rates of MAEs among patients undergoing NCS within 30 days of TAVR and those receiving surgery at 31-60 days, 61-90 days, or after 90 days. The important take-home message of this study is that the timing of TAVR and NCS does not affect the outcome of NCS. The risk of NCS depends on the risk and urgency of NCS but not on the time interval between TAVR and NCS. Additional prospective studies are indicated to define the optimal timing and duration of antithrombotic therapy in patients undergoing NCS immediately following TAVR.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention
Keywords: Surgical Procedures, Operative, Transcatheter Aortic Valve Replacement
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