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

Gilbert H L Tang*, Syed Zaid, Neal S Kleiman, Sachin S Goel, Shinichi Fukuhara, Mateo Marin-Cuartas, Philipp Kiefer, Mohamed Abdel-Wahab, Ole De Backer, Lars Søndergaard, Shekhar Saha, Christian Hagl, Moritz Wyler von Ballmoos, Oliver Bhadra, Lenard Conradi, Kendra J Grubb, Emily Shih, J Michael DiMaio, Molly Szerlip, Keti VitanovaHendrik 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

*Corresponding author af dette arbejde

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.

OriginalsprogEngelsk
TidsskriftJACC. Cardiovascular interventions
Vol/bind16
Udgave nummer8
Sider (fra-til)927-941
Antal sider15
ISSN1936-8798
DOI
StatusUdgivet - 24 apr. 2023

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