Prior cardiac surgery (PCS) is a key factor influencing treatment strategies and outcomes in patients undergoing aortic valve replacement. A registry-based analysis from the Netherlands Heart Registration published in the Journal of Cardiothoracic Surgery assessed clinical profiles, procedural selection, and long-term outcomes of transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) in patients aged 50–75 years with PCS.

The study included 1,284 patients treated between 2015 and 2020, of whom 690 (54%) underwent TAVI and 594 (46%) underwent SAVR. Previous coronary artery bypass grafting (CABG) was more common in the TAVI group (57% vs 40%), whereas prior aortic valve surgery was more frequent in the SAVR group (25% vs 51%) (p<0.001 for both). 

TAVI recipients were older (median 71 vs 67 years; p<0.001) and had higher surgical risk scores (EuroSCORE II: 5.7 vs 4.4; p=0.003). Treatment allocation reflected risk stratification, with SAVR preferred in intermediate-risk patients (62%) and TAVI more frequently selected in high- and prohibitive-risk groups (62% and 94%).

Determinants favoring TAVI included left ventricular ejection fraction ≤30% (OR 4.8; 95% CI 2.6–8.8), poor mobility (OR 3.4; 95% CI 1.6–7.0), and obesity/cachexia (OR 2.7; 95% CI 1.6–4.4). SAVR selection was associated with native aortic regurgitation (OR 0.1; 95% CI 0.1–0.3) and failing bioprostheses (OR 0.7; 95% CI 0.5–1.0). Survival at 30 days, 1 year, and 5 years was 97% vs 96%, 83% vs 91%, and 56% vs 83% for TAVI and SAVR, respectively (p<0.001).

TAVI and SAVR showed distinct selection patterns based on risk and clinical features. Severe left ventricular dysfunction and chronic lung disease were key predictors of mortality across both strategies.