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

Gilbert H.L. Tang, Syed Zaid, Neal S. Kleiman, Sachin S. Goel, Shinichi Fukuhara, Mateo Marin-Cuartas, Philipp Kiefer, Mohamed Abdel-Wahab, Ole De Backer, Lars Søndergaard, Shekhar Saha, Christian Hagl, Moritz Wyler von Ballmoos, Oliver Bhadra, Lenard Conradi, Kendra J. Grubb, Emily Shih, J. Michael DiMaio, Molly Szerlip, Keti VitanovaHendrik Ruge, Axel Unbehaun, Jorg Kempfert, Luigi Pirelli, Chad A. Kliger, Nicholas Van Mieghem, Thijmen W. Hokken, Rik Adrichem, Thomas Modine, Silvia Corona, Lin Wang, George Petrossian, Newell Robinson, David Meier, John G. Webb, Anson Cheung, Basel Ramlawi, Howard C. Herrmann, Nimesh D. Desai, Martin Andreas, Markus Mach, Ron Waksman, Christian C. Schults, Hasan Ahmad, Joshua B. Goldberg, Arnar Geirsson, John K. Forrest, Paolo Denti, Igor Belluschi, Walid Ben-Ali, Anita W. Asgar, Maurizio Taramasso, Joshua D. Rovin, Marco Di Eusanio, Andrea Colli, Tsuyoshi Kaneko, Tamim N. Nazif, Martin B. Leon, Vinayak N. Bapat, Michael J. Mack, Michael J. Reardon, Janarthanan Sathananthan

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


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.

Original languageEnglish
Pages (from-to)927-941
Number of pages15
JournalJACC: Cardiovascular Interventions
Issue number8
StatePublished - Apr 24 2023


  • TAVR explantation
  • paravalvular leak
  • prosthesis–patient mismatch
  • redo-TAVR
  • structural valve degeneration
  • surgical aortic valve replacement
  • transcatheter aortic valve replacement
  • transcatheter valve failure


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