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% 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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