BACKGROUND Recent reports have demonstrated worse than expected outcomes of surgical explantation after transcatheter aortic valve replacement (TAVR). However in-depth analysis of the short-and mid-term risk of concomitant cardiac surgery at the time of TAVR explant is lacking. METHODS Data from the multicenter EXPLANT-TAVR registry of patients undergoing TAVR-explant between November 2009 and September 2020 were retrospectively analyzed. Patients undergoing concomitant procedures were included, but explants performed during the same admission as the initial TAVR or concomitant procedures performed on the aortic root, ascending aorta, or arch were excluded. Outcomes were evaluated between the isolated surgical aortic valve replacement (SAVR) and concomitant SAVR groups. Median follow-up was 6.6 months. RESULTS Among 199 patients, concomitant SAVR was performed in 94 patients (47.2%), primarily with mitral valve surgery (n = 45) followed by coronary artery bypass grafting (n = 23). Despite similar mean ages between groups (72.8 vs 73.4 years), concomitant SAVR had a higher median Society of Thoracic Surgeons Predicted Risk of Mortality score at the index TAVR (5.9% vs 3.7%, P = .001). There were no differences in median time-to-explant between groups (12.9 vs 8.7 months, P = .78). However concomitant SAVR had longer mean cardiopulmonary bypass (166 vs 114 minutes, P = .001) and cross -clamp times (123 vs 81 minutes, P = .001). Both 30-day (16.7% vs 9.9%) and 1-year mortality (36.1% vs 22.1%) were higher with concomitant SAVR but did not reach statistical significance (both P > .05). On Kaplan-Meier analysis, actuarial estimates of cumulative survival were significantly lower with concomitant SAVR at 3 years (56.8% vs 81.1%, P = .020). CONCLUSIONS For surgical explantation after TAVR failure, concomitant SAVR is associated with increased mortality. Further studies with longer follow-up are warranted to examine the benefit from earlier intervention before concomitant disease develops. (Ann Thorac Surg 2023;116:933-43) (c) 2023 by The Society of Thoracic Surgeons. Published by Elsevier Inc.
Surgical Explantation of Failed Transcatheter Aortic Valve Replacement / Zaid, Syed; Hirji, Sameer A.; Bapat, Vinayak N.; Denti, Paolo; Modine, Thomas; Nguyen, Tom C.; Mack, Michael J.; Reardon, Michael J.; Kaneko, Tsuyoshi; Tang, Gilbert H. L.; Saha, Shekhar; Kiefer, Philipp; Holzhey, David; Noack, Thilo; Voisine, Pierre; Mohammadi, Siamak; Harrington, Katherine B.; Squiers, John J.; Fukuhara, Shinichi; von Ballmoos, Moritz Wyler; Goel, Sachin S.; Atkins, Marvin D.; Bhadra, Oliver D.; Conradi, Lenard; Shults, Christian; Satler, Lowell F.; Pirelli, Luigi; Brinster, Derek R.; Algadheeb, Muhanad; Chu, Michael W. A.; Bagur, Rodrigo; Ramlawi, Basel; Grubb, Kendra J.; Desai, Nimesh D.; Robinson, Newell B.; Wang, Lin; Petrossian, George A.; Leroux, Lionel; Doty, John R.; Kempfert, Joerg; Unbehaun, Axel; Rahim, Hussein; Geirsson, Arnar; Forrest, John K.; Vincent, Flavien; Van Belle, Eric; Koussa, Mohamad; Goldberg, Joshua B.; Ahmad, Hasan A.; Ben Ali, Walid; Demers, Philippe; Ibrahim, Reda; Andreas, Martin; Werner, Paul; Goel, Kashish; Shah, Ashish S.; Gelpi, Guido; Ruel, Marc; Al-Atassi, Talal; Van Mieghem, Nicholas M.; Hokken, Thijmen W.; D'Onofrio, Augusto; Tessari, Chiara; Shah, Pinak B.; Belluschi, Igor; Garatti, Andrea; Bruschi, Giuseppe; Ouzounian, Maral; Pizano, Alejandro; Di Eusanio, Marco; Capestro, Filippo; Rovin, Joshua; Taramasso, Maurizio; Gennari, Marco; Colli, Andrea; Estevez-Loureiro, Rodrigo; Pinon, Miguel A.; Salinger, Michael H.; Di Virgilio, Antonio; Whisenant, Brian K.; Nazif, Tamim M.; Kleiman, Neal S.; Szerlip, Molly I.; Waksman, Ron; Rodés-Cabau, Josep; George, Isaac; Dimaio, J. Michael; Maisano, Francesco; Deeb, G. Michael; Vitanova, Keti; Lange, Rudiger; Borger, Michael A.; Hagl, Christian; Bavaria, Joseph E.. - In: ANNALS OF THORACIC SURGERY. - ISSN 0003-4975. - 116:5(2023), pp. 933-942. [10.1016/j.athoracsur.2023.05.036]
Surgical Explantation of Failed Transcatheter Aortic Valve Replacement
Di Eusanio, Marco;Capestro, Filippo;Gennari, Marco;
2023-01-01
Abstract
BACKGROUND Recent reports have demonstrated worse than expected outcomes of surgical explantation after transcatheter aortic valve replacement (TAVR). However in-depth analysis of the short-and mid-term risk of concomitant cardiac surgery at the time of TAVR explant is lacking. METHODS Data from the multicenter EXPLANT-TAVR registry of patients undergoing TAVR-explant between November 2009 and September 2020 were retrospectively analyzed. Patients undergoing concomitant procedures were included, but explants performed during the same admission as the initial TAVR or concomitant procedures performed on the aortic root, ascending aorta, or arch were excluded. Outcomes were evaluated between the isolated surgical aortic valve replacement (SAVR) and concomitant SAVR groups. Median follow-up was 6.6 months. RESULTS Among 199 patients, concomitant SAVR was performed in 94 patients (47.2%), primarily with mitral valve surgery (n = 45) followed by coronary artery bypass grafting (n = 23). Despite similar mean ages between groups (72.8 vs 73.4 years), concomitant SAVR had a higher median Society of Thoracic Surgeons Predicted Risk of Mortality score at the index TAVR (5.9% vs 3.7%, P = .001). There were no differences in median time-to-explant between groups (12.9 vs 8.7 months, P = .78). However concomitant SAVR had longer mean cardiopulmonary bypass (166 vs 114 minutes, P = .001) and cross -clamp times (123 vs 81 minutes, P = .001). Both 30-day (16.7% vs 9.9%) and 1-year mortality (36.1% vs 22.1%) were higher with concomitant SAVR but did not reach statistical significance (both P > .05). On Kaplan-Meier analysis, actuarial estimates of cumulative survival were significantly lower with concomitant SAVR at 3 years (56.8% vs 81.1%, P = .020). CONCLUSIONS For surgical explantation after TAVR failure, concomitant SAVR is associated with increased mortality. Further studies with longer follow-up are warranted to examine the benefit from earlier intervention before concomitant disease develops. (Ann Thorac Surg 2023;116:933-43) (c) 2023 by The Society of Thoracic Surgeons. Published by Elsevier Inc.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
