TY - JOUR
T1 - Aortic valve versus root surgery after failed transcatheter aortic valve replacement
AU - EXPLANT-TAVR Investigators
AU - Vitanova, Keti
AU - Zaid, Syed
AU - Tang, Gilbert H.L.
AU - Kaneko, Tsuyoshi
AU - Bapat, Vinayak N.
AU - Modine, Thomas
AU - Denti, Paolo
AU - Saha, Shekhar
AU - Hagl, Christian
AU - Kiefer, Philipp
AU - Holzhey, David
AU - Noack, Thilo
AU - Borger, Michael A.
AU - Desai, Nimesh D.
AU - Bavaria, Joseph E.
AU - Voisine, MDPierre D.P.
AU - Mohammadi, Siamak
AU - Rodés-Cabau, Josep
AU - Harrington, Katherine B.
AU - Squiers, John J.
AU - Szerlip, Molly I.
AU - DiMaio, J. Michael
AU - Mack, Michael J.
AU - Rovin, Joshua
AU - Gennari, Marco
AU - Fukuhara, Shinichi
AU - Deeb, G. Michael
AU - Sengupta, Aditya
AU - Demers, Philippe
AU - Ibrahim, Reda
AU - Wyler von Ballmoos, Moritz
AU - Atkins, Marvin D.
AU - Kleiman, Neal S.
AU - Reardon, Michael J.
AU - Maisano, Francesco
AU - Bhadra, Oliver D.
AU - Conradi, Lenard
AU - Shults, Christian
AU - Satler, Lowell F.
AU - Waksman, Ron
AU - Pirelli, Luigi
AU - Brinster, Derek R.
AU - Algadheeb, Muhanad
AU - Chu, Michael W.A.
AU - Bagur, Rodrigo
AU - Ramlawi, Basel
AU - Grubb, Kendra J.
AU - Robinson, Newell B.
AU - Wang, Lin
AU - Petrossian, George A.
N1 - Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
PY - 2023/11
Y1 - 2023/11
N2 - OBJECTIVE: We sought to determine outcomes of aortic valve replacement (AVR) versus root replacement after transcatheter AVR (TAVR) explantation because they remain unknown.METHODS: From November 2009 to September 2020, data from the EXPLANT-TAVR International Registry of patients who underwent TAVR explant were retrospectively reviewed, divided by AVR versus root replacement. After excluding explants performed during the same admission as the initial TAVR and concomitant procedures involving the other valves, 168 AVR cases were compared with 28 root replacements, and outcomes were reported at 30 days and 1 year.RESULTS: Among 196 patients (mean age, 73.5 ± 9.9 years) who had primary aortic valve intervention at TAVR explant, the median time from TAVR to surgical explant was 11.2 months (interquartile range, 4.4-32.9 months). Indications for explant were similar between the 2 groups. Compared with AVR, patients requiring root replacement had fewer comorbidities but more unfavorable anatomy for redo TAVR (52.6% vs 26.4%; P = .032), fewer urgent/emergency cases (32.1% vs 58.3%; P = .013), longer median interval from index TAVR to TAVR explant (17.6 vs 9.9 months; P = .047), and more concomitant ascending aortic replacement (58.8% vs 14.0%; P < .001). Median follow-up was 6.9 months (interquartile range, 1.4-21.6 months) after TAVR explant and 97.4% complete. Overall survival at follow-up was 81.2% with no differences between groups (log rank P = .54). In-hospital, 30-day, and 1-year mortality rates and stroke rates were not different between the 2 groups.CONCLUSIONS: In the EXPLANT-TAVR Registry, AVR and root replacement groups had different clinical characteristics, but no differences in short-term mortality and morbidities. Further investigations are necessary to identify patients at risk of root replacement in TAVR explant.
AB - OBJECTIVE: We sought to determine outcomes of aortic valve replacement (AVR) versus root replacement after transcatheter AVR (TAVR) explantation because they remain unknown.METHODS: From November 2009 to September 2020, data from the EXPLANT-TAVR International Registry of patients who underwent TAVR explant were retrospectively reviewed, divided by AVR versus root replacement. After excluding explants performed during the same admission as the initial TAVR and concomitant procedures involving the other valves, 168 AVR cases were compared with 28 root replacements, and outcomes were reported at 30 days and 1 year.RESULTS: Among 196 patients (mean age, 73.5 ± 9.9 years) who had primary aortic valve intervention at TAVR explant, the median time from TAVR to surgical explant was 11.2 months (interquartile range, 4.4-32.9 months). Indications for explant were similar between the 2 groups. Compared with AVR, patients requiring root replacement had fewer comorbidities but more unfavorable anatomy for redo TAVR (52.6% vs 26.4%; P = .032), fewer urgent/emergency cases (32.1% vs 58.3%; P = .013), longer median interval from index TAVR to TAVR explant (17.6 vs 9.9 months; P = .047), and more concomitant ascending aortic replacement (58.8% vs 14.0%; P < .001). Median follow-up was 6.9 months (interquartile range, 1.4-21.6 months) after TAVR explant and 97.4% complete. Overall survival at follow-up was 81.2% with no differences between groups (log rank P = .54). In-hospital, 30-day, and 1-year mortality rates and stroke rates were not different between the 2 groups.CONCLUSIONS: In the EXPLANT-TAVR Registry, AVR and root replacement groups had different clinical characteristics, but no differences in short-term mortality and morbidities. Further investigations are necessary to identify patients at risk of root replacement in TAVR explant.
KW - TAVR explantation
KW - TAVR failure
KW - aortic root replacement
KW - surgical aortic valve replacement
KW - transcatheter aortic valve replacement
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U2 - 10.1016/j.jtcvs.2021.12.060
DO - 10.1016/j.jtcvs.2021.12.060
M3 - Article
C2 - 35525801
AN - SCOPUS:85123865567
SN - 0022-5223
VL - 166
SP - 1418-1430.e4
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 5
ER -