Syed Zaid; Neal Kleiman; Sachin  S. Goel; Molly  I. Szerlip; Michael  J. Mack; Mateo Marin-Cuartas; Siamak Mohammadi; Tamim  M. Nazif; Axel Unbehaun; Martin Andreas; Derek  R. Brinster; Newell  B. Robinson; Lin Wang; Basel Ramlawi; Lenard Conradi; Nimesh Desai; John  K. Forrest; Rodrigo Bagur; Tom  C. Nguyen; Ron Waksman; Lionel Leroux; Eric Van Belle; Kendra  J. Grubb; Hasan Ahmad; Paolo Denti; Thomas Modine; Vinayak  N. Bapat; Tsuyoshi Kaneko; Michael  J. Reardon; Gilbert  H.L. Tang; on behalf of the EXPLANT-TAVR registry investigators

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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