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.
Explant vs Redo-TAVR After Transcatheter Valve Failure / Tang, Gilbert H. L.; Zaid, Syed; Kleiman, Neal S.; Goel, Sachin S.; Fukuhara, Shinichi; Marin-Cuartas, Mateo; Kiefer, Philipp; Abdel-Wahab, Mohamed; De Backer, Ole; Søndergaard, Lars; Saha, Shekhar; Hagl, Christian; Wyler von Ballmoos, Moritz; Bhadra, Oliver; Conradi, Lenard; Grubb, Kendra J.; Shih, Emily; Dimaio, J. Michael; Szerlip, Molly; Vitanova, Keti; Ruge, Hendrik; Unbehaun, Axel; Kempfert, Jorg; Pirelli, Luigi; Kliger, Chad A.; Van Mieghem, Nicholas; Hokken, Thijmen W.; Adrichem, Rik; Modine, Thomas; Corona, Silvia; Wang, Lin; Petrossian, George; Robinson, Newell; Meier, David; Webb, John G.; Cheung, Anson; Ramlawi, Basel; Herrmann, Howard C.; Desai, Nimesh D.; Andreas, Martin; Mach, Markus; Waksman, Ron; Schults, Christian C.; Ahmad, Hasan; Goldberg, Joshua B.; Geirsson, Arnar; Forrest, John K.; Denti, Paolo; Belluschi, Igor; Ben-Ali, Walid; Asgar, Anita W.; Taramasso, Maurizio; Rovin, Joshua D.; Di Eusanio, Marco; Colli, Andrea; Kaneko, Tsuyoshi; Nazif, Tamim N.; Leon, Martin B.; Bapat, Vinayak N.; Mack, Michael J.; Reardon, Michael J.; Sathananthan, Janarthanan. - In: JACC: CARDIOVASCULAR INTERVENTIONS. - ISSN 1936-8798. - 16:8(2023), pp. 927-941. [10.1016/j.jcin.2023.01.376]
Explant vs Redo-TAVR After Transcatheter Valve Failure
Di Eusanio, Marco;
2023-01-01
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
