Aortic valve versus root surgery after failed transcatheter aortic valve replacement

Keti Vitanova; Syed Zaid; Gilbert H L Tang; Tsuyoshi Kaneko; Vinayak N Bapat; Thomas Modine; Paolo Denti; EXPLANT-TAVR Investigators

doi:10.1016/j.jtcvs.2021.12.060

Aortic valve versus root surgery after failed transcatheter aortic valve replacement

J Thorac Cardiovasc Surg. 2023 Nov;166(5):1418-1430.e4. doi: 10.1016/j.jtcvs.2021.12.060. Epub 2022 Mar 26.

Authors

Keti Vitanova¹, Syed Zaid², Gilbert H L Tang³, Tsuyoshi Kaneko⁴, Vinayak N Bapat⁵, Thomas Modine⁶, Paolo Denti⁷; EXPLANT-TAVR Investigators

Collaborators

EXPLANT-TAVR Investigators:
Shekhar Saha, Christian Hagl, Philipp Kiefer, David Holzhey, Thilo Noack, Michael A Borger, Nimesh D Desai, Joseph E Bavaria, MDPierre Voisine, Siamak Mohammadi, Josep Rodés-Cabau, Katherine B Harrington, John J Squiers, Molly I Szerlip, J Michael DiMaio, Michael J Mack, Joshua Rovin, Marco Gennari, Shinichi Fukuhara, G Michael Deeb, Aditya Sengupta, Philippe Demers, Reda Ibrahim, Moritz Wyler von Ballmoos, Marvin D Atkins, Neal S Kleiman, Michael J Reardon, Francesco Maisano, Oliver D Bhadra, Lenard Conradi, Christian Shults, Lowell F Satler, Ron Waksman, Luigi Pirelli, Derek R Brinster, Muhanad Algadheeb, Michael W A Chu, Rodrigo Bagur, Basel Ramlawi, Kendra J Grubb, Newell B Robinson, Lin Wang, George A Petrossian, Lionel Leroux, John R Doty, Brian K Whisenant, Joerg Kempfert, Axel Unbehaun, Hussein Rahim, Tamim M Nazif, Isaac George, Arnar Geirsson, John K Forrest, Flavien Vincent, Eric Van Belle, Mohamad Koussa, Joshua B Goldberg, Hasan A Ahmad, Walid Ben Ali, Martin Andreas, Paul Werner, Kashish Goel, Ashish S Shah, Guido Gelpi, Marc Ruel, Talal Al-Atassi, Nicholas M Van Mieghem, Thijmen W Hokken, Augusto D'Onofrio, Chiara Tessari, Sameer Hirji, Pinak B Shah, Igor Belluschi, Andrea Garatti, Giuseppe Bruschi, Maral Ouzounian, Alejandro Pizano, Marco Di Eusanio, Filippo Capestro, Maurizio Taramasso, Andrea Colli, Rodrigo Estevez-Loureiro, Miguel A Pinon, Michael H Salinger, Antonio Di Virgilio, Tom C Nguyen, Rudiger Lange

Affiliations

¹ German Heart Center Munich, Munich, Germany. Electronic address: vitanova@dhm.mhn.de.
² Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex.
³ Mount Sinai Health System, New York, NY.
⁴ Brigham & Women's Hospital, Boston, Mass.
⁵ Abbott Northwestern Hospital, Minneapolis, Minn.
⁶ CHU Bordeaux, Bordeaux, France.
⁷ San Raffaele University Hospital, Milan, Italy.

PMID: 35525801
DOI: 10.1016/j.jtcvs.2021.12.060

Abstract

Objective: We sought to determine outcomes of aortic valve replacement (AVR) versus root replacement after transcatheter AVR (TAVR) explantation because they remain unknown.

Methods: From November 2009 to September 2020, data from the EXPLANT-TAVR International Registry of patients who underwent TAVR explant were retrospectively reviewed, divided by AVR versus root replacement. After excluding explants performed during the same admission as the initial TAVR and concomitant procedures involving the other valves, 168 AVR cases were compared with 28 root replacements, and outcomes were reported at 30 days and 1 year.

Results: Among 196 patients (mean age, 73.5 ± 9.9 years) who had primary aortic valve intervention at TAVR explant, the median time from TAVR to surgical explant was 11.2 months (interquartile range, 4.4-32.9 months). Indications for explant were similar between the 2 groups. Compared with AVR, patients requiring root replacement had fewer comorbidities but more unfavorable anatomy for redo TAVR (52.6% vs 26.4%; P = .032), fewer urgent/emergency cases (32.1% vs 58.3%; P = .013), longer median interval from index TAVR to TAVR explant (17.6 vs 9.9 months; P = .047), and more concomitant ascending aortic replacement (58.8% vs 14.0%; P < .001). Median follow-up was 6.9 months (interquartile range, 1.4-21.6 months) after TAVR explant and 97.4% complete. Overall survival at follow-up was 81.2% with no differences between groups (log rank P = .54). In-hospital, 30-day, and 1-year mortality rates and stroke rates were not different between the 2 groups.

Conclusions: In the EXPLANT-TAVR Registry, AVR and root replacement groups had different clinical characteristics, but no differences in short-term mortality and morbidities. Further investigations are necessary to identify patients at risk of root replacement in TAVR explant.

Keywords: TAVR explantation; TAVR failure; aortic root replacement; surgical aortic valve replacement; transcatheter aortic valve replacement.