TY - JOUR
T1 - Explant vs Redo-TAVR After Transcatheter Valve Failure
T2 - Mid-Term Outcomes From the EXPLANTORREDO-TAVR International Registry
AU - Tang, Gilbert H.L.
AU - Zaid, Syed
AU - Kleiman, Neal S.
AU - Goel, Sachin S.
AU - Fukuhara, Shinichi
AU - Marin-Cuartas, Mateo
AU - Kiefer, Philipp
AU - Abdel-Wahab, Mohamed
AU - De Backer, Ole
AU - Søndergaard, Lars
AU - Saha, Shekhar
AU - Hagl, Christian
AU - Wyler von Ballmoos, Moritz
AU - Bhadra, Oliver
AU - Conradi, Lenard
AU - Grubb, Kendra J.
AU - Shih, Emily
AU - DiMaio, J. Michael
AU - Szerlip, Molly
AU - Vitanova, Keti
AU - Ruge, Hendrik
AU - Unbehaun, Axel
AU - Kempfert, Jorg
AU - Pirelli, Luigi
AU - Kliger, Chad A.
AU - Van Mieghem, Nicholas
AU - Hokken, Thijmen W.
AU - Adrichem, Rik
AU - Modine, Thomas
AU - Corona, Silvia
AU - Wang, Lin
AU - Petrossian, George
AU - Robinson, Newell
AU - Meier, David
AU - Webb, John G.
AU - Cheung, Anson
AU - Ramlawi, Basel
AU - Herrmann, Howard C.
AU - Desai, Nimesh D.
AU - Andreas, Martin
AU - Mach, Markus
AU - Waksman, Ron
AU - Schults, Christian C.
AU - Ahmad, Hasan
AU - Goldberg, Joshua B.
AU - Geirsson, Arnar
AU - Forrest, John K.
AU - Denti, Paolo
AU - Belluschi, Igor
AU - Ben-Ali, Walid
AU - Asgar, Anita W.
AU - Taramasso, Maurizio
AU - Rovin, Joshua D.
AU - Di Eusanio, Marco
AU - Colli, Andrea
AU - Kaneko, Tsuyoshi
AU - Nazif, Tamim N.
AU - Leon, Martin B.
AU - Bapat, Vinayak N.
AU - Mack, Michael J.
AU - Reardon, Michael J.
AU - Sathananthan, Janarthanan
N1 - Publisher Copyright:
© 2023 American College of Cardiology Foundation
PY - 2023/4/24
Y1 - 2023/4/24
N2 - BACKGROUND: Valve reintervention after transcatheter aortic valve replacement (TAVR) failure has not been studied in detail.OBJECTIVES: The authors sought to determine outcomes of TAVR surgical explantation (TAVR-explant) vs redo-TAVR because they are largely unknown.METHODS: From May 2009 to February 2022, 396 patients in the international EXPLANTORREDO-TAVR registry underwent TAVR-explant (181, 46.4%) or redo-TAVR (215, 54.3%) for transcatheter heart valve (THV) failure during a separate admission from the initial TAVR. Outcomes were reported at 30 days and 1 year.RESULTS: The incidence of reintervention after THV failure was 0.59% with increasing volume during the study period. Median time from index-TAVR to reintervention was shorter in TAVR-explant vs redo-TAVR (17.6 months [IQR: 5.0-40.7 months] vs 45.7 months [IQR: 10.6-75.6 months]; P < 0.001], respectively. TAVR-explant had more prosthesis-patient mismatch (17.1% vs 0.5%; P < 0.001) as the indication for reintervention, whereas redo-TAVR had more structural valve degeneration (63.7% vs 51.9%; P = 0.023), with a similar incidence of ≥moderate paravalvular leak between groups (28.7% vs 32.8% in redo-TAVR; P = 0.44). There was a similar proportion of balloon-expandable THV failures (39.8% TAVR-explant vs 40.5% redo-TAVR; P = 0.92). Median follow-up was 11.3 (IQR: 1.6-27.1 months) after reintervention. Compared with redo-TAVR, TAVR-explant had higher mortality at 30 days (13.6% vs 3.4%; P < 0.001) and 1 year (32.4% vs 15.4%; P = 0.001), with similar stroke rates between groups. On landmark analysis, mortality was similar between groups after 30 days (P = 0.91).CONCLUSIONS: In this first report of the EXPLANTORREDO-TAVR global registry, TAVR-explant had a shorter median time to reintervention, with less structural valve degeneration, more prosthesis-patient mismatch, and similar paravalvular leak rates compared with redo-TAVR. TAVR-explant had higher mortality at 30 days and 1 year, but similar rates on landmark analysis after 30 days.
AB - BACKGROUND: Valve reintervention after transcatheter aortic valve replacement (TAVR) failure has not been studied in detail.OBJECTIVES: The authors sought to determine outcomes of TAVR surgical explantation (TAVR-explant) vs redo-TAVR because they are largely unknown.METHODS: From May 2009 to February 2022, 396 patients in the international EXPLANTORREDO-TAVR registry underwent TAVR-explant (181, 46.4%) or redo-TAVR (215, 54.3%) for transcatheter heart valve (THV) failure during a separate admission from the initial TAVR. Outcomes were reported at 30 days and 1 year.RESULTS: The incidence of reintervention after THV failure was 0.59% with increasing volume during the study period. Median time from index-TAVR to reintervention was shorter in TAVR-explant vs redo-TAVR (17.6 months [IQR: 5.0-40.7 months] vs 45.7 months [IQR: 10.6-75.6 months]; P < 0.001], respectively. TAVR-explant had more prosthesis-patient mismatch (17.1% vs 0.5%; P < 0.001) as the indication for reintervention, whereas redo-TAVR had more structural valve degeneration (63.7% vs 51.9%; P = 0.023), with a similar incidence of ≥moderate paravalvular leak between groups (28.7% vs 32.8% in redo-TAVR; P = 0.44). There was a similar proportion of balloon-expandable THV failures (39.8% TAVR-explant vs 40.5% redo-TAVR; P = 0.92). Median follow-up was 11.3 (IQR: 1.6-27.1 months) after reintervention. Compared with redo-TAVR, TAVR-explant had higher mortality at 30 days (13.6% vs 3.4%; P < 0.001) and 1 year (32.4% vs 15.4%; P = 0.001), with similar stroke rates between groups. On landmark analysis, mortality was similar between groups after 30 days (P = 0.91).CONCLUSIONS: In this first report of the EXPLANTORREDO-TAVR global registry, TAVR-explant had a shorter median time to reintervention, with less structural valve degeneration, more prosthesis-patient mismatch, and similar paravalvular leak rates compared with redo-TAVR. TAVR-explant had higher mortality at 30 days and 1 year, but similar rates on landmark analysis after 30 days.
KW - paravalvular leak
KW - prosthesis–patient mismatch
KW - redo-TAVR
KW - structural valve degeneration
KW - surgical aortic valve replacement
KW - TAVR explantation
KW - transcatheter aortic valve replacement
KW - transcatheter valve failure
KW - Heart Valve Prosthesis Implantation
KW - Humans
KW - Heart Valve Prosthesis
KW - Risk Factors
KW - Transcatheter Aortic Valve Replacement/adverse effects
KW - Treatment Outcome
KW - Prosthesis Design
KW - Aortic Valve Stenosis/diagnostic imaging
KW - Registries
KW - Aortic Valve/diagnostic imaging
UR - http://www.scopus.com/inward/record.url?scp=85152746476&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85152746476&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2023.01.376
DO - 10.1016/j.jcin.2023.01.376
M3 - Article
C2 - 37100556
AN - SCOPUS:85152746476
SN - 1936-8798
VL - 16
SP - 927
EP - 941
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 8
ER -