The Annals of thoracic surgery · 2026
Long-Term Outcomes of Repeated Transcatheter Aortic Valve Replacement vs Transcatheter Aortic Valve Replacement Explantation: A Nationwide Analysis.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Faggion Vinholo Thais, Awtry Jake, Cho Mansoo, Allen Philip, Semco Robert, Hirji Sameer, McGurk Siobhan, Newell Paige, Harloff Morgan, Sundt Thoralf M, Tolis George, Shah Pinak B, Kaneko Tsuyoshi, Osho Asishana, Sabe Ashraf A
Аннотация
BACKGROUND: Comparative durability of subsequent procedures after transcatheter aortic valve replacement (TAVR) remains unclear. This study aimed to assess long-term outcomes of repeated TAVR vs TAVR explantation for bioprosthetic valve dysfunction after TAVR.
METHODS: Medicare beneficiaries undergoing aortic valve reintervention after index TAVR (January 2012-December 2020) were assigned to repeated TAVR or TAVR explantation categories. Exclusion criteria included endocarditis or reintervention during the same admission. Primary outcome was 5-year mortality; secondary outcomes included major adverse cardiovascular events (death, pacemaker placement, major bleeding, stroke, acute kidney injury, cardiac arrest). Time-to-event analyses used Kaplan-Meier curves. Adjusted outcomes were assessed by 1:1 propensity matching.
RESULTS: Of 1172 patients undergoing reintervention after TAVR, 70.6% had repeated TAVR and 29.4% had TAVR explantation. Repeated TAVR patients were older and more often female, with higher Charlson comorbidity score (all P < .05). Median follow-up was 29.2 months (27.7 months repeated TAVR, 32.3 months TAVR explantation). In the propensity score-matched cohorts, 30- and 90-day mortality was higher after TAVR explantation, but Kaplan-Meier estimated cumulative mortality was lower in TAVR explantation at 3 and 5 years (all P < .001). Survival curves crossed at approximately 9 months, after which TAVR explantation maintained a persistent advantage. The hazard ratio during the entire follow-up was 0.61 (95% CI, 0.49-0.75; P < .001). Similar survival patterns were observed across Charlson comorbidity stratification and after exclusion of concomitant procedures.
CONCLUSIONS: Although repeated TAVR showed lower short-term mortality, long-term outcomes favored TAVR explantation. These findings suggest that for Medicare beneficiaries experiencing TAVR failure, there is a subset of patients who could benefit from TAVR explantation over repeated TAVR.
METHODS: Medicare beneficiaries undergoing aortic valve reintervention after index TAVR (January 2012-December 2020) were assigned to repeated TAVR or TAVR explantation categories. Exclusion criteria included endocarditis or reintervention during the same admission. Primary outcome was 5-year mortality; secondary outcomes included major adverse cardiovascular events (death, pacemaker placement, major bleeding, stroke, acute kidney injury, cardiac arrest). Time-to-event analyses used Kaplan-Meier curves. Adjusted outcomes were assessed by 1:1 propensity matching.
RESULTS: Of 1172 patients undergoing reintervention after TAVR, 70.6% had repeated TAVR and 29.4% had TAVR explantation. Repeated TAVR patients were older and more often female, with higher Charlson comorbidity score (all P < .05). Median follow-up was 29.2 months (27.7 months repeated TAVR, 32.3 months TAVR explantation). In the propensity score-matched cohorts, 30- and 90-day mortality was higher after TAVR explantation, but Kaplan-Meier estimated cumulative mortality was lower in TAVR explantation at 3 and 5 years (all P < .001). Survival curves crossed at approximately 9 months, after which TAVR explantation maintained a persistent advantage. The hazard ratio during the entire follow-up was 0.61 (95% CI, 0.49-0.75; P < .001). Similar survival patterns were observed across Charlson comorbidity stratification and after exclusion of concomitant procedures.
CONCLUSIONS: Although repeated TAVR showed lower short-term mortality, long-term outcomes favored TAVR explantation. These findings suggest that for Medicare beneficiaries experiencing TAVR failure, there is a subset of patients who could benefit from TAVR explantation over repeated TAVR.