Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov;166(5):1418-1430.e4.
doi: 10.1016/j.jtcvs.2021.12.060. Epub 2022 Mar 26.

Aortic valve versus root surgery after failed transcatheter aortic valve replacement

Keti Vitanova  1 , Syed Zaid  2 , Gilbert H L Tang  3 , Tsuyoshi Kaneko  4 , Vinayak N Bapat  5 , Thomas Modine  6 , Paolo Denti  7 ; EXPLANT-TAVR Investigators
Collaborators, Affiliations
Free article

Aortic valve versus root surgery after failed transcatheter aortic valve replacement

Keti Vitanova et al. J Thorac Cardiovasc Surg. 2023 Nov.
Free article

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.

PubMed Disclaimer

LinkOut - more resources