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.