Explant vs Redo-TAVR After Transcatheter Valve Failure: Mid-Term Outcomes From the EXPLANTORREDO-TAVR International Registry.
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Tang Gilbert H L, Zaid Syed, Kleiman Neal S, Goel Sachin S, Fukuhara Shinichi, Marin-Cuartas Mateo, Kiefer Philipp, Abdel-Wahab Mohamed, De Backer Ole, Søndergaard Lars, Saha Shekhar, Hagl Christian, Wyler von Ballmoos Moritz, Bhadra Oliver, Conradi Lenard, Grubb Kendra J, Shih Emily, DiMaio J Michael, Szerlip Molly, Vitanova Keti, Ruge Hendrik, Unbehaun Axel, Kempfert Jorg, Pirelli Luigi, Kliger Chad A, Van Mieghem Nicholas, Hokken Thijmen W, Adrichem Rik, Modine Thomas, Corona Silvia, Wang Lin, Petrossian George, Robinson Newell, Meier David, Webb John G, Cheung Anson, Ramlawi Basel, Herrmann Howard C, Desai Nimesh D, Andreas Martin, Mach Markus, Waksman Ron, Schults Christian C, Ahmad Hasan, Goldberg Joshua B, Geirsson Arnar, Forrest John K, Denti Paolo, Belluschi Igor, Ben-Ali Walid, Asgar Anita W, Taramasso Maurizio, Rovin Joshua D, Di Eusanio Marco, Colli Andrea, Kaneko Tsuyoshi, Nazif Tamim N, Leon Martin B, Bapat Vinayak N, Mack Michael J, Reardon Michael J, Sathananthan Janarthanan
Аннотация
OBJECTIVES: The authors sought to determine outcomes of TAVR surgical explantation (TAVR-explant) vs redo-TAVR because they are largely unknown.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.