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Zaid S, Kleiman NS, Goel SS, Szerlip MI, Mack MJ, Marin-Cuartas M, Mohammadi S, Nazif TM, Unbehaun A, Andreas M, Brinster DR, Robinson NB, Wang L, Ramlawi B, Conradi L, Desai ND, Forrest JK, Bagur R, Nguyen TC, Waksman R, Leroux L, Van Belle E, Grubb KJ, Ahmad HA, Denti P, Modine T, Bapat VN, Kaneko T, Reardon MJ, Tang GHL, Explant-Tavr Registry Investigators OBOT. Impact of transcatheter heart valve type on outcomes of surgical explantation after failed transcatheter aortic valve replacement: the EXPLANT-TAVR international registry. EUROINTERVENTION 2024; 20:e146-e157. [PMID: 38224255 PMCID: PMC10786178 DOI: 10.4244/eij-d-23-00722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/16/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND There are limited data on the impact of transcatheter heart valve (THV) type on the outcomes of surgical explantation after THV failure. AIMS We sought to determine the outcomes of transcatheter aortic valve replacement (TAVR) explantation for failed balloon-expandable valves (BEV) versus self-expanding valves (SEV). METHODS From November 2009 to February 2022, 401 patients across 42 centres in the EXPLANT-TAVR registry underwent TAVR explantation during a separate admission from the initial TAVR. Mechanically expandable valves (N=10, 2.5%) were excluded. The outcomes of TAVR explantation were compared for 202 (51.7%) failed BEV and 189 (48.3%) failed SEV. RESULTS Among 391 patients analysed (mean age: 73.0±9.8 years; 33.8% female), the median time from index TAVR to TAVR explantation was 13.3 months (interquartile range 5.1-34.8), with no differences between groups. Indications for TAVR explantation included endocarditis (36.0% failed SEV vs 55.4% failed BEV; p<0.001), paravalvular leak (21.2% vs 11.9%; p=0.014), structural valve deterioration (30.2% vs 21.8%; p=0.065) and prosthesis-patient mismatch (8.5% vs 10.4%; p=0.61). The SEV group trended fewer urgent/emergency surgeries (52.0% vs 62.3%; p=0.057) and more root replacement (15.3% vs 7.4%; p=0.016). Concomitant cardiac procedures were performed in 57.8% of patients, including coronary artery bypass graft (24.8%), and mitral (38.9%) and tricuspid (14.6%) valve surgery, with no differences between groups. In-hospital, 30-day, and 1-year mortality and stroke rates were similar between groups (allp>0.05), with no differences in cumulative mortality at 3 years (log-rank p=0.95). On multivariable analysis, concomitant mitral surgery was an independent predictor of 1-year mortality after BEV explant (hazard ratio [HR] 2.00, 95% confidence interval [CI]: 1.07-3.72) and SEV explant (HR 2.00, 95% CI: 1.08-3.69). CONCLUSIONS In the EXPLANT-TAVR global registry, BEV and SEV groups had different indications for surgical explantation, with more root replacements in SEV failure, but no differences in midterm mortality and morbidities. Further refinement of TAVR explantation techniques are important to improving outcomes.
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Affiliation(s)
- Syed Zaid
- Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | | | | | | | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Québec City, QC, Canada
| | - Tamim M Nazif
- Columbia University Irving Medical Center, New York, NY, USA
| | | | | | | | | | - Lin Wang
- St. Francis Hospital, Roslyn, NY, USA
| | | | - Lenard Conradi
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | | | - Rodrigo Bagur
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Tom C Nguyen
- University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Ron Waksman
- MedStar Washington Hospital Center, Washington, D.C., USA
| | | | | | | | | | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | | | | | - Tsuyoshi Kaneko
- Washington University School of Medicine, St. Louis, MO, USA
| | - Michael J Reardon
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
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