Surgery after transcatheter aortic valve interventions

Abstract

Associate Editor's Introduction-Aortic valve replacement, whether performed open or percutaneously, inherently trades the native valve disease for a new disease by virtue of the prosthetic valve. Both approaches have pitfalls and complications early, from the procedure itself (eg, heart block, perivalvular leak, ventricular injury, coronary artery ostial impingement), and later (eg, prosthetic valve endocarditis, structural valve deterioration [SVD]). With transcatheter aortic valve replacement (TAVR), even after successful deployment, the biological nature of the valve implies that SVD will eventually occur, and the risks of thrombosis and prosthetic valve endocarditis remain. With the progression of TAVR use in lower-risk cohorts, including younger patients, the long-term consequences should remain in the back of the surgeon's mind. In this invited review, the authors have provided the readership with a concise summary of issues facing surgeons involved in TAVR in both the acute and long-term periods. This summary is just that, a summary of the potential issues and some potential solutions, but it reminds us that no procedure or technique is free of complications. Knowledge and understanding of these potential complications are critical in the optimal care of our patients.

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

“…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.…”

Commentary: An ounce of prevention

“…In this issue of JTCVS Techniques , Burke and colleagues 1 present a timely review of surgery following transcatheter aortic valve replacement (TAVR). As TAVR becomes more prevalent and its application attempts to expand to younger and lower-risk patients, cardiac surgeons must be equipped to address acute and late failures that require surgical intervention.…”

“…As TAVR becomes more prevalent and its application attempts to expand to younger and lower-risk patients, cardiac surgeons must be equipped to address acute and late failures that require surgical intervention. The innovation of TAVR has caused a new surgical pathology, and our colleagues 1 have provided a pathway to prepare for what is come.…”

“…Burke and colleagues 1 appropriately emphasize the importance of formal discussion by the multidisciplinary heart team with the patient and family of the risks of complications as well as candidacy and prognosis for salvage interventions. Candidacy for bailout and detailed plans for the approach should be reviewed by the procedural team as part of the preprocedure briefing.…”

“…Clearly defining which patients are not candidates for bailout procedures will help to prevent futile salvage operations. The authors 1 nicely outline the technical challenges, such as adherence of the prosthesis to the native leaflets and ingrowth of the prosthetic material into the subannular and supra-annular tissue, especially with a self-expanding prosthesis. Aortic root replacement, with its attendant complexity and greater risk, frequently is required.…”