Valvular & structural heart diseaseCohort study
Impact of Initial Valve Type on Reintervention for Transcatheter Aortic Valve Replacement (TAVR) Failure: From the EXPLANTORREDO-TAVR International Registry
- international registry
- 29 centers
Authors' conclusion
Failed-BEV and failed-SEV showed distinct failure mechanisms and timing of reintervention, but initial valve type did not impact reintervention strategy or survival after redo-TAVR or TAVR-explant.
Study context
- Population
- Patients who underwent redo-TAVR or TAVR-explant for TAVR failure during a separate admission from index TAVR, May 2009 to February 2022; mechanically expanding valves and explantation for endocarditis excludedunderwent redo-TAVR or TAVR-explant for TAVR failure, 158 failed-BEV compared with 224 failed-SEV · failed-BEV 158 · failed-SEV 224
- Participants
- 553 patients
- Exposure
- failed-BEV vs failed-SEV
- failed-BEVn = 158reference
- failed-SEVn = 224
Main finding
As reported in the abstract
P = 0.85
Observational data: associations, not effects.
Further findings
Mortality · 1 year
P = 0.65
Failure mechanism and time-to-reintervention
Structural valve deterioration
Prosthesis-patient mismatch
Paravalvular leak
Time-to-reintervention failed-BEV 41.8 months · failed-SEV 19.7 months
Reintervention strategy
redo TAVR
TAVR-explant
received SEV (cross-platform redo-TAVR) failed-BEV 58.1%
received BEV (cross-platform redo-TAVR) failed-SEV 59.2%
| Outcome | adjusted hazard ratio (CI) | P value | |
|---|---|---|---|
| Risk-adjusted 3-year cumulative mortality, stratified by reintervention type · redo TAVR; ref: failed-BEV · no differences | 1.15 (0.61–2.20) | ||
| Risk-adjusted 3-year cumulative mortality, stratified by reintervention type · TAVR-explant · no differences | 0.84 (0.46–1.54) | ||
| 0.512Adjusted hazard ratio (log scale) |
- Failure mechanism and time-to-reintervention: structural valve deterioration P <0.001
- Failure mechanism and time-to-reintervention: prosthesis-patient mismatch P =0.022
- Failure mechanism and time-to-reintervention: paravalvular leak P <0.001
- Failure mechanism and time-to-reintervention: time-to-reintervention P <0.001
- Reintervention strategy: strategy P =0.92
- Reintervention strategy: cross-platform P =0.016
Baseline characteristics at reintervention
- Mean age at reintervention
- 75.5±9.3 years
- Female
- 40.6%
Original publication
Summarised from the published abstract; every number is checked against it