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Surgical Explantation of Failed Transcatheter Aortic Valve Replacement

2023; Elsevier BV; Volume: 116; Issue: 5 Linguagem: Inglês

10.1016/j.athoracsur.2023.05.036

1552-6259

Syed Zaid, Sameer Hirji, Vinayak Bapat, Paolo Denti, Thomas Modine, Tom C. Nguyen, Michael J. Mack, Michael J. Reardon, Tsuyoshi Kaneko, Gilbert H.L. Tang, Shekhar Saha, Philipp Kiefer, David Holzhey, Thilo Noack, Pierre Voisine, Siamak Mohammadi, Katherine Harrington, John J. Squiers, Shinichi Fukuhara, Moritz Wyler von Ballmoos, Sachin S. Goel, Marvin D. Atkins, Oliver D. Bhadra, Lenard Conradi, Christian Shults, Lowell F. Satler, Luigi Pirelli, Derek R. Brinster, Muhanad Algadheeb, Michael Chu, Rodrigo Bagur, Basel Ramlawi, Kendra J. Grubb, Nimesh D. Desai, N. Bryce Robinson, Lin Wang, George Petrossian, Lionel Leroux, John R. Doty, Jörg Kempfert, Axel Unbehaun, Hussein Rahim, Arnar Geirsson, John K. Forrest, Flavien Vincent, Eric Van Belle, Mohamad Koussa, Joshua Goldberg, Hasan Ahmad, Walid Ben Ali, Philippe Demers, Reda Ibrahim, 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, Pinak Shah, Igor Belluschi, Andrea Garatti, Giuseppe Bruschi, Maral Ouzounian, Alejandro Pizano, Marco Di Eusanio, Filippo Capestro, Joshua D. Rovin, Maurizio Taramasso, Marco Gennari, Andrea Colli, Rodrigo Estévez‐Loureiro, Miguel Piñón, Michael H. Salinger, Antonio Di Virgilio, Brian Whisenant, Tamim Nazif, Neal S. Kleiman, Molly Szerlip, Ron Waksman, Josep Rodés‐Cabau, Isaac George, J. Michael DiMaio, Francesco Maisano, G. Michael Deeb, Keti Vitanova, Rüdiger Lange, Michael A. Borger, Christian Hagl, Joseph E. Bavaria,

Coronary Interventions and Diagnostics

Recent reports have demonstrated worse than expected outcomes of surgical explantation after transcatheter aortic valve replacement (TAVR). However in-depth analysis of the short- and mid-term risk of concomitant cardiac surgery at the time of TAVR explant is lacking.Data from the multicenter EXPLANT-TAVR registry of patients undergoing TAVR-explant between November 2009 and September 2020 were retrospectively analyzed. Patients undergoing concomitant procedures were included, but explants performed during the same admission as the initial TAVR or concomitant procedures performed on the aortic root, ascending aorta, or arch were excluded. Outcomes were evaluated between the isolated surgical aortic valve replacement (SAVR) and concomitant SAVR groups. Median follow-up was 6.6 months.Among 199 patients, concomitant SAVR was performed in 94 patients (47.2%), primarily with mitral valve surgery (n = 45) followed by coronary artery bypass grafting (n = 23). Despite similar mean ages between groups (72.8 vs 73.4 years), concomitant SAVR had a higher median Society of Thoracic Surgeons Predicted Risk of Mortality score at the index TAVR (5.9% vs 3.7%, P = .001). There were no differences in median time-to-explant between groups (12.9 vs 8.7 months, P = .78). However concomitant SAVR had longer mean cardiopulmonary bypass (166 vs 114 minutes, P = .001) and cross-clamp times (123 vs 81 minutes, P = .001). Both 30-day (16.7% vs 9.9%) and 1-year mortality (36.1% vs 22.1%) were higher with concomitant SAVR but did not reach statistical significance (both P > .05). On Kaplan-Meier analysis, actuarial estimates of cumulative survival were significantly lower with concomitant SAVR at 3 years (56.8% vs 81.1%, P = .020).For surgical explantation after TAVR failure, concomitant SAVR is associated with increased mortality. Further studies with longer follow-up are warranted to examine the benefit from earlier intervention before concomitant disease develops.