Abstract 4368041: Perioperative Outcomes of Non-Cardiac Surgery Early after Transcatheter Aortic Valve Implantation

Abstract

Introduction: Approximately 17.2 million inpatient noncardiac surgeries (NCS) are performed annually in the US. Risk assessment prior to NCS is critical to mitigate perioperative major adverse cardiovascular complications (MACE). Data on safety of NCS early after transcatheter aortic valve implantation (TAVI) for aortic stenosis is limited. Research Question: What are the contemporary outcomes of NCS early after TAVI? Methods: Patients undergoing major NCS from 2018-2024 who had a TAVI procedure within the prior 2 years were identified from the Vizient® Clinical Data Base, and stratified by time from TAVI to index NCS. The primary endpoint was MACE (a composite of death, MI, stroke). Components of MACE and bleeding were evaluated. Outcomes of NCS early (<6 months) after TAVI were compared to those of NCS >6 months after TAVI, and to outcomes of NCS after surgical aortic valve replacement (SAVR). Multivariate logistic or Firth's bias-reduced logistic regression were used to estimate the odds of MACE adjusted for covariates: age, sex, race, surgery type, and modified Revised Cardiac Risk Index components. Data from the Vizient Clinical Data Base were used with the permission of Vizient (all rights reserved). Results: A total of 8,232 patients undergoing NCS within 2 years of TAVI, and 4,011 patients undergoing NCS within 2 years of SAVR, were identified. NCS early (<6 months) after TAVI was not associated with excess MACE versus NCS >6 months after TAVI for all timepoints: <1 month (12.5%, adjusted odds ratio [aOR] 0.79; 0.59-1.05), 1-3 month (9.6%, aOR 0.73; 0.56-0.97), 3-6 months (10.8% aOR 0.94; 0.72-1.24) versus 11.5% at >6 months. No differences in odds of MACE were observed for NCS after TAVI versus NCS after SAVR at corresponding time intervals: <1 month (12.5% vs 12.2%, aOR 0.86; 0.57-1.29), 1-3 months (9.6% vs 8.4%, aOR 0.67; 0.36-1.25), 3-6 months (10.8% vs 9.3% aOR 0.76; 0.41-1.41), >6 months (11.5% vs 9.3%, aOR 1.23; 0.90-1.69). NCS <1 month after TAVI was associated with a lower risk of MI (<1 month: 4.0% vs 4.7%, aOR 0.66; 0.47-0.93) and higher risk of bleeding (<1 month: 17.8% vs 5.0% aOR 3.54; 2.85-4.42) compared to NCS >6 months after TAVI. Conclusions Risks of perioperative MACE in patients undergoing NCS early after TAVI were not different from those >6 months after TAVI or at corresponding timepoints after SAVR, although bleeding risks were higher early after TAVI. NCS early after TAVI may be a reasonable strategy when surgery is time sensitive.