Surgical Bailout During TAVR: A Contemporary Analysis of the Centers for Medicare and Medicaid Services Database.

Background

Surgical bailout during transcatheter aortic valve replacement (TAVR) may be necessary to manage emergent TAVR complications. With discussions of performing TAVR in U.S. hospitals without in-hospital cardiac surgery support, analysis of TAVR bailout on a national level is needed.

Objectives

This study sought to analyze the annual trends and outcomes of TAVR bailout.

Methods

This study included Medicare beneficiaries who underwent TAVR between 2016 and 2024. Annual trends of bailout were analyzed. The primary outcome was 30-day mortality. Additionally, the impact of hospital surgical aortic valve replacement (SAVR) volume on TAVR bailout mortality was assessed with multivariable analysis.

Results

TAVR bailout occurred in 0.56% (2,240/400,862) of TAVRs. The annual incidence of TAVR bailout decreased from 0.92% (261/28,430) in 2016 to 0.40% (216/54,301) in 2024 (P < 0.001). The median follow-up time after TAVR was 952 days (IQR: 414-1,615 days). The 30-day mortality rate of TAVR bailout was 26.3% (588/2,240). Landmark analysis demonstrated higher mortality of TAVR bailout compared to TAVR without bailout up to 1 year after TAVR (P < 0.001), but similar mortality was seen after 1 year (P = 0.53). When compared across low-, intermediate-, and high-volume SAVR hospitals in a multilevel hierarchal model, 30-day mortality was similar (27% [102/383] vs 29% [163/566] vs 25% [322/1,291], respectively; P = 0.28).

Conclusions

In contemporary data, the annual incidence of TAVR surgical bailout is decreasing, but the short-term mortality remains high. However, patients who survived 1 year after TAVR had similar long-term mortality to patients without surgical bailout. These data support the need for continued cardiac surgical support in TAVR centers to manage emergent complications.