Explant vs Redo-TAVR After Transcatheter Valve Failure: Mid-Term Outcomes From the EXPLANTORREDO-TAVR International Registry

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

  • Gilbert H.L. Tang
  • Syed Zaid
  • Neal S. Kleiman
  • Sachin S. Goel
  • Shinichi Fukuhara
  • Mateo Marin-Cuartas
  • Philipp Kiefer
  • Mohamed Abdel-Wahab
  • Shekhar Saha
  • Christian Hagl
  • Moritz Wyler von Ballmoos
  • Oliver Bhadra
  • Lenard Conradi
  • Kendra J. Grubb
  • Emily Shih
  • J. Michael DiMaio
  • Molly Szerlip
  • Keti Vitanova
  • Hendrik Ruge
  • Axel Unbehaun
  • Jorg Kempfert
  • Luigi Pirelli
  • Chad A. Kliger
  • Nicholas Van Mieghem
  • Thijmen W. Hokken
  • Rik Adrichem
  • Thomas Modine
  • Silvia Corona
  • Lin Wang
  • George Petrossian
  • Newell Robinson
  • David Meier
  • John G. Webb
  • Anson Cheung
  • Basel Ramlawi
  • Howard C. Herrmann
  • Nimesh D. Desai
  • Martin Andreas
  • Markus Mach
  • Ron Waksman
  • Christian C. Schults
  • Hasan Ahmad
  • Joshua B. Goldberg
  • Arnar Geirsson
  • John K. Forrest
  • Paolo Denti
  • Igor Belluschi
  • Walid Ben-Ali
  • Anita W. Asgar
  • Maurizio Taramasso
  • Joshua D. Rovin
  • Marco Di Eusanio
  • Andrea Colli
  • Tsuyoshi Kaneko
  • Tamim N. Nazif
  • Martin B. Leon
  • Vinayak N. Bapat
  • Michael J. Mack
  • Michael J. Reardon
  • Janarthanan Sathananthan

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.

OriginalsprogEngelsk
TidsskriftJACC: Cardiovascular Interventions
Vol/bind16
Udgave nummer8
Sider (fra-til)927-941
Antal sider15
ISSN1936-8798
DOI
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
The authors thank all the coinvestigators for their participation and involvement in the EXPLANTORREDO-TAVR registry.

Publisher Copyright:
© 2023 American College of Cardiology Foundation

ID: 369989931