Original Research

DOI: 10.4244/EIJ-D-23-00722

Impact of transcatheter heart valve type on outcomes of surgical explantation after failed transcatheter aortic valve replacement: the EXPLANT-TAVR international registry

Syed Zaid1, MD; Neal S. Kleiman2, MD; Sachin S. Goel2, MD; Molly I. Szerlip3, MD; Michael J. Mack3, MD; Mateo Marin-Cuartas4, MD; Siamak Mohammadi5, MD; Tamim M. Nazif6, MD; Axel Unbehaun7, MD; Martin Andreas8, MD, PhD; Derek R. Brinster9, MD; Newell B. Robinson10, MD; Lin Wang10, MD; Basel Ramlawi11, MD; Lenard Conradi12, MD; Nimesh D. Desai13, MD, PhD; John K. Forrest14, MD; Rodrigo Bagur15, MD, PhD; Tom C. Nguyen16, MD; Ron Waksman17, MD; Lionel Leroux18, MD; Eric Van Belle19, MD; Kendra J. Grubb20, MD, MHA; Hasan A. Ahmad21, MD; Paolo Denti22, MD; Thomas Modine18, MD, PhD, MBA; Vinayak N. Bapat23, MBBS; Tsuyoshi Kaneko24, MD; Michael J. Reardon2, MD; Gilbert H.L. Tang25, MD, MSc, MBA; on behalf of the EXPLANT-TAVR registry investigators

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%...

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Volume 20 Number 2
Jan 15, 2024
Volume 20 Number 2
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