10-year experience with transcatheter aortic valve explants in a high-volume center.

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.