TY - JOUR
T1 - Surgical Explantation After TAVR Failure
T2 - Mid-Term Outcomes From the EXPLANT-TAVR International Registry
AU - EXPLANT-TAVR Investigators
AU - Bapat, Vinayak N.
AU - Zaid, Syed
AU - Fukuhara, Shinichi
AU - Saha, Shekhar
AU - Vitanova, Keti
AU - Kiefer, Philipp
AU - Squiers, John J.
AU - Voisine, Pierre
AU - Pirelli, Luigi
AU - von Ballmoos, Moritz Wyler
AU - Chu, Michael W.A.
AU - Rodés-Cabau, Josep
AU - DiMaio, J. Michael
AU - Borger, Michael A.
AU - Lange, Rudiger
AU - Hagl, Christian
AU - Denti, Paolo
AU - Modine, Thomas
AU - Kaneko, Tsuyoshi
AU - Tang, Gilbert H.L.
AU - Sengupta, Aditya
AU - Holzhey, David
AU - Noack, Thilo
AU - Harrington, Katherine B.
AU - Mohammadi, Siamak
AU - Brinster, Derek R.
AU - Atkins, Marvin D.
AU - Algadheeb, Muhanad
AU - Bagur, Rodrigo
AU - Desai, Nimesh D.
AU - Bhadra, Oliver D.
AU - Conradi, Lenard
AU - Shults, Christian
AU - Satler, Lowell F.
AU - Ramlawi, Basel
AU - Robinson, Newell B.
AU - Wang, Lin
AU - Petrossian, George A.
AU - Andreas, Martin
AU - Werner, Paul
AU - Garatti, Andrea
AU - Vincent, Flavien
AU - Van Belle, Eric
AU - Juthier, Francis
AU - Leroux, Lionel
AU - Doty, John R.
AU - Goldberg, Joshua B.
AU - Reardon, Michael J.
AU - Goel, Sachin
AU - Kleiman, Neal
N1 - Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/9/27
Y1 - 2021/9/27
N2 - Objectives: The aim of this study was to evaluate clinical characteristics, mechanisms of failure, and outcomes of transcatheter aortic valve replacement (TAVR) explantation. Background: Surgical explantation following TAVR may be required for structural valve degeneration, paravalvular leak, infection, or other reasons. However, in-depth data on indications and outcomes are lacking. Methods: Data from a multicenter, international registry (EXPLANT-TAVR) of patients who underwent TAVR explantation were reviewed retrospectively. Explantations performed during the same admission as initial TAVR were excluded. Clinical and echocardiographic outcomes were evaluated. Median follow-up duration was 6.7 months (interquartile range [IQR]: 1.0-18.8 months) after TAVR explantation and was 97.7% complete at 30 days and 86.1% complete at 1 year. Results: From November 2009 to September 2020, 269 patients across 42 centers with a mean age of 72.7 ± 10.4 years underwent TAVR explantation. About one quarter (25.9%) were deemed low surgical risk at index TAVR, and median Society of Thoracic Surgeons risk at TAVR explantation was 5.6% (IQR: 3.2%-9.6%). The median time to explantation was 11.5 months (IQR: 4.0-32.4 months). Balloon-expandable and self-expanding or mechanically expandable valves accounted for 50.9% and 49.1%, respectively. Indications for explantation included endocarditis (43.1%), structural valve degeneration (20.1%), paravalvular leak (18.2%), and prosthesis-patient mismatch (10.8%). Redo TAVR was not feasible because of unfavorable anatomy in 26.8% of patients. Urgent or emergency cases were performed in 53.1% of patients, aortic root replacement in 13.4%, and 54.6% had concomitant cardiac procedures. Overall survival at last follow-up was 76.1%. In-hospital, 30-day, and 1-year mortality rates were 11.9%, 13.1%, and 28.5%, respectively, and stroke rates were 5.9%, 8.6%, and 18.7%, respectively. Conclusions: The EXPLANT-TAVR registry reveals that surgical risks associated with TAVR explantation are not negligible and should be taken into consideration in the lifetime management of aortic stenosis.
AB - Objectives: The aim of this study was to evaluate clinical characteristics, mechanisms of failure, and outcomes of transcatheter aortic valve replacement (TAVR) explantation. Background: Surgical explantation following TAVR may be required for structural valve degeneration, paravalvular leak, infection, or other reasons. However, in-depth data on indications and outcomes are lacking. Methods: Data from a multicenter, international registry (EXPLANT-TAVR) of patients who underwent TAVR explantation were reviewed retrospectively. Explantations performed during the same admission as initial TAVR were excluded. Clinical and echocardiographic outcomes were evaluated. Median follow-up duration was 6.7 months (interquartile range [IQR]: 1.0-18.8 months) after TAVR explantation and was 97.7% complete at 30 days and 86.1% complete at 1 year. Results: From November 2009 to September 2020, 269 patients across 42 centers with a mean age of 72.7 ± 10.4 years underwent TAVR explantation. About one quarter (25.9%) were deemed low surgical risk at index TAVR, and median Society of Thoracic Surgeons risk at TAVR explantation was 5.6% (IQR: 3.2%-9.6%). The median time to explantation was 11.5 months (IQR: 4.0-32.4 months). Balloon-expandable and self-expanding or mechanically expandable valves accounted for 50.9% and 49.1%, respectively. Indications for explantation included endocarditis (43.1%), structural valve degeneration (20.1%), paravalvular leak (18.2%), and prosthesis-patient mismatch (10.8%). Redo TAVR was not feasible because of unfavorable anatomy in 26.8% of patients. Urgent or emergency cases were performed in 53.1% of patients, aortic root replacement in 13.4%, and 54.6% had concomitant cardiac procedures. Overall survival at last follow-up was 76.1%. In-hospital, 30-day, and 1-year mortality rates were 11.9%, 13.1%, and 28.5%, respectively, and stroke rates were 5.9%, 8.6%, and 18.7%, respectively. Conclusions: The EXPLANT-TAVR registry reveals that surgical risks associated with TAVR explantation are not negligible and should be taken into consideration in the lifetime management of aortic stenosis.
KW - TAVR explantation
KW - TAVR failure
KW - surgical aortic valve replacement
KW - transcatheter aortic valve replacement
UR - http://www.scopus.com/inward/record.url?scp=85114697806&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85114697806&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2021.07.015
DO - 10.1016/j.jcin.2021.07.015
M3 - Article
C2 - 34556271
AN - SCOPUS:85114697806
SN - 1936-8798
VL - 14
SP - 1978
EP - 1991
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 18
ER -