Impact of TAVR Failure Mechanism on Outcomes After Reintervention: From the EXPLANTORREDO-TAVR Registry.
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Penta Bhavanadhar, Tang Gilbert H L, Abdel-Wahab Mohamed, Adrichem Rik, Ahmad Hasan, Andreas Martin, Asgar Anita W, Belluschi Igor, Ben-Ali Walid, Bhadra Oliver D, Cheung Anson, Colli Andrea, Conradi Lenard, Corona Silvia, De Backer Ole, Denti Paolo, Desai Nimesh D, Di Eusanio Marco, DiMaio J Michael, Forrest John K, Fukuhara Shinichi, Geirsson Arnar, Goel Sachin S, Goldberg Joshua B, Hagl Christian, Herrmann Howard C, Hokken Thijmen W, Kempfert Jorg, Kiefer Philipp, Kleiman Neal S, Kliger Chad, Mach Markus, Marin-Cuartas Mateo, Meier David, Modine Thomas, Petrossian George, Pirelli Luigi, Ramlawi Basel, Robinson Newell B, Rovin Joshua D, Ruge Hendrik, Saha Shekhar, Schults Christian C, Shih Emily, Szerlip Molly, Taramasso Maurizio, Unbehaun Axel, Van Mieghem Nicolas M, Vitanova Keti, Waksman Ron, Wang Lin, Webb John G, Wyler von Ballmoos Moritz C, Reardon Michael J, Nazif Tamim N, Leon Martin B, Mack Michael J, Kaneko Tsuyoshi, Bapat Vinayak N, Zaid Syed, EXPLANTORREDO-TAVR Registry Investigators
Аннотация
METHODS: From 2009 to 2022, 553 patients from 29 centers in the EXPLANTORREDO-TAVR registry (Explant or Redo Transcatheter Aortic Valve Replacement) underwent TAVR-explant or redo-TAVR for transcatheter aortic valve failure. Patients with endocarditis were excluded. Patients with structural valve deterioration (SVD, N=224 [64.9%]) were compared with those with nonstructural valve dysfunction (NSVD, N=121 [35.1%]), comprising paravalvular leak (86.0%) and prosthesis-patient mismatch (14.0%). Outcomes were assessed at 30 days and 1 year.
RESULTS: Mean age was 75.6±9.3 years, with 42% women. There were no differences in reintervention type between groups (redo-TAVR in 58.0% SVD versus 49.6% NSVD; TAVR-explant: 42.0% versus 50.4%; P=0.14). Compared with NSVD, SVD was the predominant mode of failure in balloon-expandable valves (50.7% versus 24.8%; P<0.001), had a longer time to reintervention (50.7 versus 5.5 months; P<0.001), and favored non-balloon-expandable valves at redo-TAVR (56.9% versus 33.3%; P=0.003). Mortality at 30 days and 1 year did not differ significantly between SVD and NSVD for either redo-TAVR (30 days: 3.2% versus 1.7%, P=1.00; 1 year: 18.0% versus 12.0%; P=0.47) or TAVR-explant (30 days: 16.3% versus 12.1%, P=0.63; 1 year: 40.0% versus 29.5%; P=0.39). There were also no differences in risk-adjusted 3-year cumulative mortality between groups (redo-TAVR: hazard ratio, 1.30 [95% CI, 0.68-2.46], P=0.43 [ref=NSVD]; TAVR-explant: hazard ratio, 1.24 [95% CI, 0.64-2.41]; P=0.53).
CONCLUSIONS: SVD and NSVD failures had distinct valve types and reintervention timing, with SVD having a longer time to TAVR reintervention, but the failure mechanism did not impact reintervention type or clinical outcomes.