Aortic valve versus root surgery after failed transcatheter aortic valve replacement.

Vitanova, Keti; Zaid, Syed; Tang, Gilbert H L; Kaneko, Tsuyoshi; Bapat, Vinayak N; Modine, Thomas; Denti, Paolo

doi:10.1016/j.jtcvs.2021.12.060

journal article

Title:: Aortic valve versus root surgery after failed transcatheter aortic valve replacement.
Document type:: Journal Article
Author(s):: Vitanova, Keti; Zaid, Syed; Tang, Gilbert H L; Kaneko, Tsuyoshi; Bapat, Vinayak N; Modine, Thomas; Denti, Paolo
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.
Journal title abbreviation:: J Thorac Cardiovasc Surg
Year:: 2023
Journal volume:: 166
Journal issue:: 5
Pages contribution:: 1418-1430.e4
Fulltext / DOI:: doi:10.1016/j.jtcvs.2021.12.060
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/35525801
Print-ISSN:: 0022-5223
TUM Institution:: Klinik für Herz- und Gefäßchirurgie (DHM) (Prof. Lange)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Gefäßchirurgie (DHM) (Prof. Krane)2023