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Tang, GHL; Zaid, S; Kleiman, NS; Goel, SS; Fukuhara, S; Marin-Cuartas, M; Kiefer, P; Abdel-Wahab, M; De Backer, O; Sondergaard, L; Saha, S; Hagl, C; von Ballmoos, MW; Bhadra, O; Conradi, L; Grubb, KJ; Shih, E; Michael, J; Szerlip, M; Vitanova, K; Ruge, H; Unbehaun, A; Kempfert, J; Pirelli, L; Kliger, CA; Van Mieghem, N; Hokken, TW; Adrichem, R; Modine, T; Corona, S; Wang, L; Petrossian, G; Robinson, N; Meier, D; Webb, JG; Cheung, A; Ramlawi, B; Herrmann, HC; Desai, ND; Andreas, M; Mach, M; Waksman, R; Schults, CC; Ahmad, H; Goldberg, JB; Geirsson, A; Forrest, JK; Denti, P; Belluschi, I; Ben-Ali, W; Asgar, AW; Taramasso, M; Rovin, JD; Di Eusanio, M; Colli, A; Kaneko, T; Nazif, TN; Leon, MB; Bapat, VN; Mack, MJ; Reardon, MJ; Sathananthan, J.
Explant vs Redo-TAVR After Transcatheter Valve Failure Mid-Term Outcomes From the EXPLANTORREDO-TAVR International Registry
JACC-CARDIOVASC INTE. 2023; 16(8): 927-941. Doi: 10.1016/j.jcin.2023.01.376
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Co-authors Med Uni Graz: Andreas Martin
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Abstract:: 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. (J Am Coll Cardiol Intv 2023;16:927-941) (c) 2023 by the American College of Cardiology Foundation.
Find related publications in this database (Keywords): paravalvular leak; prosthesis- patient mismatch; redo-TAVR; structural valve degeneration; surgical aortic valve replacement; TAVR explantation; transcatheter aortic valve replacement; transcatheter valve failure