Commentary: Ready or not, here it comes: Surgery after transcatheter aortic valve replacement

Abstract

Recently, amidst all the focus on coronavirus disease 2019, a landmark has been quietly passed: For the first time in the United States, annual transcatheter aortic valve replacement (TAVR) has surpassed isolated surgical aortic valve replacement volumes, with 72,991 TAVRs performed during 2019. 1 Circumstances due to the coronavirus disease 2019 pandemic may actually favor TAVR. Limited hospital resources, strict visitation policies, shorter lengths of stay, and fewer intensive care resources have further amplified this shift in 2020. Burke, Oyetunji, and Aldea, 2 from the University of Washington, provide a concise overview of key considerations for surgery following TAVR. The authors point to the timeliness of this important topic, which will be encountered with greater frequency as increased procedure volumes generate a larger at-risk cohort. Increase in the size of the pathology pool will be driven by changes in demographic characteristics of the potential TAVR population. This will include longer life expectancy and earlier structural valve deterioration inherent to using bioprosthetic valves in a younger patient population. Appropriately, the authors highlight the different considerations and outcomes for surgical bailout during TAVR, versus surgical explant, when the valve begins to fail.Surgical bailout during TAVR occurs at an estimated frequency of about 1%, and has 30-day or index hospitalization mortality of about 50%. 3,4 Risk factors for needing surgical bailout include female sex, increasing hemoglobin