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Titel:

Explant vs Redo-TAVR After Transcatheter Valve Failure: Mid-Term Outcomes From the EXPLANTORREDO-TAVR International Registry.

Dokumenttyp:
Journal Article; Research Support, Non-U.S. Gov't
Autor(en):
Tang, Gilbert H L; Zaid, Syed; Kleiman, Neal S; Goel, Sachin S; Fukuhara, Shinichi; Marin-Cuartas, Mateo; Kiefer, Philipp; Abdel-Wahab, Mohamed; De Backer, Ole; Søndergaard, Lars; Saha, Shekhar; Hagl, Christian; Wyler von Ballmoos, Moritz; Bhadra, Oliver; Conradi, Lenard; Grubb, Kendra J; Shih, Emily; DiMaio, J Michael; Szerlip, Molly; Vitanova, Keti; Ruge, Hendrik; Unbehaun, Axel; Kempfert, Jorg; Pirelli, Luigi; Kliger, Chad A; Van Mieghem, Nicholas; Hokken, Thijmen W; Adrichem, Rik; Modine, Th...     »
Abstract:
BACKGROUND: Valve reintervention after transcatheter aortic valve replacement (TAVR) failure has not been studied in detail. OBJECTIVES: The authors sought to determine outcomes of TAVR surgical explantation (TAVR-explant) vs redo-TAVR because they are largely unknown. METHODS: From May 2009 to February 2022, 396 patients in the international EXPLANTORREDO-TAVR registry underwent TAVR-explant (181, 46.4%) or redo-TAVR (215, 54.3%) for transcatheter heart valve (THV) failure during a separate admission from the initial TAVR. Outcomes were reported at 30 days and 1 year. RESULTS: The incidence of reintervention after THV failure was 0.59% with increasing volume during the study period. Median time from index-TAVR to reintervention was shorter in TAVR-explant vs redo-TAVR (17.6 months [IQR: 5.0-40.7 months] vs 45.7 months [IQR: 10.6-75.6 months]; P < 0.001], respectively. TAVR-explant had more prosthesis-patient mismatch (17.1% vs 0.5%; P < 0.001) as the indication for reintervention, whereas redo-TAVR had more structural valve degeneration (63.7% vs 51.9%; P = 0.023), with a similar incidence of ≥moderate paravalvular leak between groups (28.7% vs 32.8% in redo-TAVR; P = 0.44). There was a similar proportion of balloon-expandable THV failures (39.8% TAVR-explant vs 40.5% redo-TAVR; P = 0.92). Median follow-up was 11.3 (IQR: 1.6-27.1 months) after reintervention. Compared with redo-TAVR, TAVR-explant had higher mortality at 30 days (13.6% vs 3.4%; P < 0.001) and 1 year (32.4% vs 15.4%; P = 0.001), with similar stroke rates between groups. On landmark analysis, mortality was similar between groups after 30 days (P = 0.91). CONCLUSIONS: In this first report of the EXPLANTORREDO-TAVR global registry, TAVR-explant had a shorter median time to reintervention, with less structural valve degeneration, more prosthesis-patient mismatch, and similar paravalvular leak rates compared with redo-TAVR. TAVR-explant had higher mortality at 30 days and 1 year, but similar rates on landmark analysis after 30 days.
Zeitschriftentitel:
JACC Cardiovasc Interv
Jahr:
2023
Band / Volume:
16
Heft / Issue:
8
Seitenangaben Beitrag:
927-941
Volltext / DOI:
doi:10.1016/j.jcin.2023.01.376
PubMed:
http://view.ncbi.nlm.nih.gov/pubmed/37100556
Print-ISSN:
1936-8798
TUM Einrichtung:
592; Klinik für Herz- und Gefäßchirurgie (DHM) (Prof. Lange)
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