Cardiovascular revascularization medicine : including molecular interventions · 2026
10-year experience with transcatheter aortic valve explants in a high-volume center.
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Szekely Marcell, Lopez-Trevino Maria G, Gecse Imre I, Kritya Mangesh, Kharsa Chloe, Sarfaraz Ziyab K, Aoun Joe, Reul Ross M, Quarti Andrea G, Lawrie Gerald M, Goel Sachin S, Ramchandani Mahesh, Del Val Fernando Ramirez, Kleiman Neal S, Reardon Michael J, Atkins Marvin D
Аннотация
OBJECTIVE: Indications for transcatheter aortic valve replacement (TAVR) are expanding into younger, lower-risk patients, and TAVR explants are increasing. We report our 10-year single-center experience and outcomes following TAVR explant.
METHODS: All TAVR explants performed between January 2015 and September 2025 were retrospectively reviewed. Patients were stratified into early-explant (≤30 days from index TAVR) and late-explant (>30 days) groups. Late-explant patients were further categorized as lower-risk (SAVR after TAVR risk score ≤ 8) or high-risk (>8). The primary endpoint was operative mortality; secondary endpoints included observed-to-expected (O/E) mortality and midterm survival.
RESULTS: Sixty-six TAVR explants were performed: 9 (13.6%) early and 57 (86.4%) late. Among late explants, 40 (70.2%) were lower-risk and 17 (29.8%) high-risk. Median time to explant in this cohort was 37.3 months (IQR:17.2-66.1). Indications were structural valve degeneration (33.3%), endocarditis (30%), valve thrombosis (6.1%), non-structural dysfunction (16.7%) and acute causes (13.6%). Within the late-explant cohort, only 13 patients (22.8%) had an isolated aortic valve replacement; most required concomitant procedures. Operative mortality was 22.2% for early and 15.8% for late explants. Among late cases, operative mortality was higher in the high-risk group (41.2% vs 5%, p = 0.002), with a substantially increased O/E mortality ratio (2.81 vs 1.40). Survival at 1, 2, and 3 years was 82.8%, 78.4%, and 65.8% in the lower-risk group versus 45.3% at all time points in the high-risk group.
CONCLUSIONS: TAVR explantation carries operative mortality higher than anticipated, particularly in high-risk patients. A TAVR-first strategy in younger and lower-risk populations warrants careful consideration within a lifetime management framework.
METHODS: All TAVR explants performed between January 2015 and September 2025 were retrospectively reviewed. Patients were stratified into early-explant (≤30 days from index TAVR) and late-explant (>30 days) groups. Late-explant patients were further categorized as lower-risk (SAVR after TAVR risk score ≤ 8) or high-risk (>8). The primary endpoint was operative mortality; secondary endpoints included observed-to-expected (O/E) mortality and midterm survival.
RESULTS: Sixty-six TAVR explants were performed: 9 (13.6%) early and 57 (86.4%) late. Among late explants, 40 (70.2%) were lower-risk and 17 (29.8%) high-risk. Median time to explant in this cohort was 37.3 months (IQR:17.2-66.1). Indications were structural valve degeneration (33.3%), endocarditis (30%), valve thrombosis (6.1%), non-structural dysfunction (16.7%) and acute causes (13.6%). Within the late-explant cohort, only 13 patients (22.8%) had an isolated aortic valve replacement; most required concomitant procedures. Operative mortality was 22.2% for early and 15.8% for late explants. Among late cases, operative mortality was higher in the high-risk group (41.2% vs 5%, p = 0.002), with a substantially increased O/E mortality ratio (2.81 vs 1.40). Survival at 1, 2, and 3 years was 82.8%, 78.4%, and 65.8% in the lower-risk group versus 45.3% at all time points in the high-risk group.
CONCLUSIONS: TAVR explantation carries operative mortality higher than anticipated, particularly in high-risk patients. A TAVR-first strategy in younger and lower-risk populations warrants careful consideration within a lifetime management framework.