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

Details

Serval ID
serval:BIB_DEE3E72E9FA8
Type
Article: article from journal or magazin.
Collection
Publications
Title
Explant vs Redo-TAVR After Transcatheter Valve Failure: Mid-Term Outcomes From the EXPLANTORREDO-TAVR International Registry.
Journal
JACC. Cardiovascular interventions
Author(s)
Tang GHL, Zaid S., Kleiman N.S., Goel S.S., Fukuhara S., Marin-Cuartas M., Kiefer P., Abdel-Wahab M., De Backer O., Søndergaard L., Saha S., Hagl C., Wyler von Ballmoos M., Bhadra O., Conradi L., Grubb K.J., Shih E., DiMaio J.M., Szerlip M., Vitanova K., Ruge H., Unbehaun A., Kempfert J., Pirelli L., Kliger C.A., Van Mieghem N., Hokken T.W., Adrichem R., Modine T., Corona S., Wang L., Petrossian G., Robinson N., Meier D., Webb J.G., Cheung A., Ramlawi B., Herrmann H.C., Desai N.D., Andreas M., Mach M., Waksman R., Schults C.C., Ahmad H., Goldberg J.B., Geirsson A., Forrest J.K., Denti P., Belluschi I., Ben-Ali W., Asgar A.W., Taramasso M., Rovin J.D., Di Eusanio M., Colli A., Kaneko T., Nazif T.N., Leon M.B., Bapat V.N., Mack M.J., Reardon M.J., Sathananthan J.
ISSN
1876-7605 (Electronic)
ISSN-L
1936-8798
Publication state
Published
Issued date
24/04/2023
Peer-reviewed
Oui
Volume
16
Number
8
Pages
927-941
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
Valve reintervention after transcatheter aortic valve replacement (TAVR) failure has not been studied in detail.
The authors sought to determine outcomes of TAVR surgical explantation (TAVR-explant) vs redo-TAVR because they are largely unknown.
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.
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).
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.
Keywords
Humans, Transcatheter Aortic Valve Replacement/adverse effects, Aortic Valve/diagnostic imaging, Aortic Valve/surgery, Heart Valve Prosthesis Implantation, Aortic Valve Stenosis/diagnostic imaging, Aortic Valve Stenosis/surgery, Heart Valve Prosthesis, Treatment Outcome, Risk Factors, Registries, Prosthesis Design, TAVR explantation, paravalvular leak, prosthesis–patient mismatch, redo-TAVR, structural valve degeneration, surgical aortic valve replacement, transcatheter aortic valve replacement, transcatheter valve failure
Pubmed
Web of science
Open Access
Yes
Create date
17/01/2025 5:42
Last modification date
24/02/2025 11:47
Usage data