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Title:

Transcatheter heart valve explant with infective endocarditis-associated prosthesis failure and outcomes: the EXPLANT-TAVR international registry.

Document type:
Journal Article; Multicenter Study
Author(s):
Marin-Cuartas, Mateo; Tang, Gilbert H L; Kiefer, Philipp; Fukuhara, Shinichi; Lange, Rudiger; Harrington, Katherine B; Saha, Shekhar; Hagl, Christian; Kleiman, Neal S; Goel, Sachin S; Kempfert, Joerg; Werner, Paul; Petrossian, George A; Geirsson, Arnar; Desai, Nimesh D; Chu, Michael W A; Bhadra, Oliver D; Shults, Christian; Garatti, Andrea; Vincent, Flavien; Grubb, Kendra J; Goldberg, Joshua B; Mack, Michael J; Modine, Thomas; Denti, Paolo; Kaneko, Tsuyoshi; Bapat, Vinayak N; Reardon, Michael J;...     »
Abstract:
BACKGROUND AND AIMS: Surgical explantation of transcatheter heart valves (THVs) is rapidly increasing, but there are limited data on patients with THV-associated infective endocarditis (IE). This study aims to assess the outcomes of patients undergoing THV explant for IE. METHODS: All patients who underwent THV explant between 2011 and 2022 from 44 sites in the EXPLANT-TAVR registry were identified. Patients with IE as the reason for THV explant were compared to those with other mechanisms of bioprosthetic valve dysfunction (BVD). RESULTS: A total of 372 patients from the EXPLANT-TAVR registry were included. Among them, 184 (49.5%) patients underwent THV explant due to IE and 188 (50.5%) patients due to BVD. At the index transcatheter aortic valve replacement, patients undergoing THV explant for IE were older (74.3 ± 8.6 vs. 71 ± 10.6 years) and had a lower Society of Thoracic Surgeons risk score [2.6% (1.8-5.0) vs. 3.3% (2.1-5.6), P = .029] compared to patients with BVD. Compared to BVD, IE patients had longer intensive care unit and hospital stays (P < .05) and higher stroke rates at 30 days (8.6% vs. 2.9%, P = .032) and 1 year (16.2% vs. 5.2%, P = .010). Adjusted in-hospital, 30-day, and 1-year mortality was 12.1%, 16.1%, and 33.8%, respectively, for the entire cohort, with no significant differences between groups. Although mortality was numerically higher in IE patients 3 years postsurgery (29.6% for BVD vs. 43.9% for IE), Kaplan-Meier analysis showed no significant differences between groups (P = .16). CONCLUSIONS: In the EXPLANT-TAVR registry, patients undergoing THV explant for IE had higher 30-day and 1-year stroke rates and longer intensive care unit and hospital stays. Moreover, patients undergoing THV explant for IE had a higher 3-year mortality rate, which did not reach statistical significance given the relatively small sample size of this unique cohort and the reduced number of events.
Journal title abbreviation:
Eur Heart J
Year:
2024
Journal volume:
45
Journal issue:
28
Pages contribution:
2519-2532
Fulltext / DOI:
doi:10.1093/eurheartj/ehae292
Pubmed ID:
http://view.ncbi.nlm.nih.gov/pubmed/38820201
Print-ISSN:
0195-668X
TUM Institution:
Klinik für Herz- und Gefäßchirurgie (DHM) (Prof. Krane)
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