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Aortic valve versus root surgery after failed transcatheter aortic valve replacement

2022; Elsevier BV; Volume: 166; Issue: 5 Linguagem: Inglês

10.1016/j.jtcvs.2021.12.060

1097-685X

Keti Vitanova, Syed Zaid, Gilbert H.L. Tang, Tsuyoshi Kaneko, Vinayak Bapat, Thomas Modine, Paolo Denti, 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 Harrington, John J. Squiers, Molly Szerlip, J. Michael DiMaio, Michael J. Mack, Joshua D. Rovin, Marco Gennari, Shinichi Fukuhara, G. Michael Deeb, Aditya Sengupta, Philippe Demers, Réda 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 Chu, Rodrigo Bagur, Basel Ramlawi, Kendra J. Grubb, N. Bryce Robinson, Lin Wang, George Petrossian, Lionel Leroux, John R. Doty, Brian Whisenant, Jörg Kempfert, Axel Unbehaun, Hussein Rahim, Tamim Nazif, Isaac George, Arnar Geirsson, John K. Forrest, Flavien Vincent, Eric Van Belle, Mohamad Koussa, Joshua Goldberg, Hasan 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 Shah, Igor Belluschi, Andrea Garatti, Giuseppe Bruschi, Maral Ouzounian, Alejandro Pizano, Marco Di Eusanio, Filippo Capestro, Maurizio Taramasso, Andrea Colli, Rodrigo Estévez‐Loureiro, Miguel Piñón, Michael H. Salinger, Antonio Di Virgilio, Tom C. Nguyen, Rüdiger Lange,

Aortic Disease and Treatment Approaches

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.