In contemporary data, the annual incidence of TAVR surgical bailout is decreasing, but the short-term mortality remains high, and these data support the need for continued cardiac surgical support in TAVR centers to manage emergent complications.
TAVR surgical bailout occurred in 0.56% of all TAVR procedures in the Medicare population between 2016 and 2024.
The annual incidence of TAVR surgical bailout decreased significantly over the study period.
The 30-day mortality rate following TAVR surgical bailout was 26.3%.
Long-term mortality after 1 year was similar between patients who underwent TAVR surgical bailout and those who did not.
Hospital surgical aortic valve replacement (SAVR) volume did not significantly affect 30-day mortality following TAVR surgical bailout.
This research analyzed what happens when a heart valve replacement procedure called TAVR (transcatheter aortic valve replacement) goes wrong and requires emergency open-heart surgery to fix — a situation known as 'surgical bailout.' Using Medicare data covering more than 400,000 TAVR procedures performed between 2016 and 2024, the researchers found that this emergency situation is becoming less common over time, dropping from about 1 in 109 procedures in 2016 to about 1 in 250 by 2024. This improvement likely reflects advances in TAVR technology and growing operator experience. Despite becoming rarer, surgical bailout remains extremely dangerous when it does occur. More than 1 in 4 patients (26.3%) who required emergency open-heart surgery during TAVR died within 30 days, and those who survived had a higher risk of death compared to uncomplicated TAVR patients for up to one year afterward. However, among patients who made it past the one-year mark, long-term survival was similar to patients who never needed a bailout. The study also found that the mortality risk during bailout was similar regardless of whether the hospital performed many or few open-heart surgeries per year. This research suggests that all hospitals performing TAVR should maintain immediate access to cardiac surgical teams, since bailout emergencies — though uncommon — carry very high mortality and can occur at any center regardless of its surgical volume. The findings add important evidence to ongoing discussions in the United States about whether TAVR should be allowed at hospitals that do not have cardiac surgery programs on site.
Braasch M, Siki M, Bai Y, Rahimi M, He J, Hanafy A, et al.. (2026). Surgical Bailout During TAVR: A Contemporary Analysis of the Centers for Medicare and Medicaid Services Database.. JACC. Cardiovascular interventions. https://doi.org/10.1016/j.jcin.2026.06.030