Valvular & structural heart disease
Impact of transcatheter heart valve type on outcomes of surgical explantation after failed transcatheter aortic valve replacement: the EXPLANT-TAVR international registry
Authors' conclusion
In the EXPLANT-TAVR global registry, BEV and SEV groups had different indications for surgical explantation, with more root replacements in SEV failure, but no differences in midterm mortality and morbidities.
Study context
- Population
- Patients undergoing surgical transcatheter aortic valve replacement (TAVR) explantation for transcatheter heart valve (THV) failure during a separate admission from the initial TAVR, November 2009 to February 2022391 analysed
- Participants
- 401 patients
- Exposure
- Explantation of failed balloon-expandable valves (BEV) vs failed self-expanding valves (SEV)
- BEVn = 202reference
- SEVn = 189
- Outcome
- Outcomes of TAVR explantation:
- Mortality
- Stroke
- Follow-up
- In-hospital, 30 days, 1 year; cumulative mortality at 3 years
Methodological detailsinternational registry, multicentre (42 centres)
- International registry
- Multicentre (42 centres)
Main finding
As reported in the abstract
- In-hospital, 30-day and 1-year mortality and stroke rates similar between groups
- all p>0.05
- No differences in cumulative mortality at 3 years
- log-rank p=0.95
Observational data: associations, not effects.
Further findings
Indications for TAVR explantation
Endocarditis
P < 0.001
Paravalvular leak
P = 0.014
Structural valve deterioration
P = 0.065
Prosthesis-patient mismatch
P = 0.61
Urgent/emergency surgery
P = 0.057
Root replacement
P = 0.016
Concomitant mitral surgery as predictor of 1-year mortality (multivariable)
| HR (95% CI) | ||
|---|---|---|
| Concomitant mitral surgeryAfter BEV explant | 2.00 (1.07–3.72) | |
| Concomitant mitral surgeryAfter SEV explant | 2.00 (1.08–3.69) | |
| 0.20.5125Hazard ratio (log scale) |
Time from index TAVR to explantation
- Median 13.3 months (IQR 5.1-34.8), no differences between groups
Concomitant cardiac procedures
- Any concomitant cardiac procedure, no differences between groups
- 57.8%
- CABG
- 24.8%
- Mitral valve surgery
- 38.9%
- Tricuspid valve surgery
- 14.6%
Original publication
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