Impact of transcatheter heart valve type on outcomes of surgical explantation after failed transcatheter aortic valve replacement: the EXPLANT-TAVR international registry

the EXPLANT-TAVR registry investigators; Syed Zaid; Neal S. Kleiman; Sachin S. Goel; Molly I. Szerlip; Michael J. Mack; Mateo Marin-Cuartas; Siamak Mohammadi; Tamim M. Nazif; Axel Unbehaun; Martin Andreas; Derek R. Brinster; Newell B. Robinson; Lin Wang; Basel Ramlawi; Lenard Conradi; Nimesh D. Desai; John K. Forrest; Rodrigo Bagur; Tom C. Nguyen; Ron Waksman; Lionel Leroux; Eric Van Belle; Kendra J. Grubb; Hasan A. Ahmad; Paolo Denti; Thomas Modine; Vinayak N. Bapat; Tsuyoshi Kaneko; Michael J. Reardon; Gilbert H.L. Tang; Giuseppe Bruschi; Katherine B. Harrington; John J. Squiers; J. Michael DiMaio; Sameer Hirji; Pinak B. Shah; Flavien Vincent; Mohammad Koussa; Isaac George; Nicholas M. Van Mieghem; Thijmen W. Hokken; Joerg Kempfert; Keti Vitanova; Rudiger Lange; Marvin D. Atkins; John R. Doty; Brian K. Whisenant; Andrea Garatti; Marco Di Eusanio; Filippo Capestro; Philipp Kiefer; David Holzhey; Thilo Noack; Michael A. Borger; Luigi Pirelli; Shekhar Saha; Christian Hagl; Muhanad Algadheeb; Michael W.A. Chu; Antonio Di Virgilio; Michael H. Salinger; Paul Werner; Christian Shults; Lowell F. Satler; Walid Ben Ali; Philippe Demers; Reda Ibrahim; Joshua Rovin; Pierre Voisine; Josep Rodés-Cabau; Guido Gelpi; Igor Belluschi; Francesco Maisano; George A. Petrossian; Maral Ouzounian; Oliver D. Bhadra; Rodrigo Estevez-Loureiro; Miguel A. Pinon; Moritz Wyler von Ballmoos; Shinichi Fukuhara; G. Michael Deeb; Marc Ruel; Talal Al-Atassi; Augusto D'Onofrio; Chiara Tessari; Joseph E. Bavaria; Andrea Colli; Alejandro Pizano; Kashish Goel; Ashish S. Shah; Joshua B. Goldberg; Arnar Geirsson; Maurizio Taramasso; Marco Gennari

doi:10.4244/EIJ-D-23-00722

Impact of transcatheter heart valve type on outcomes of surgical explantation after failed transcatheter aortic valve replacement: the EXPLANT-TAVR international registry

the EXPLANT-TAVR registry investigators, Syed Zaid, Neal S. Kleiman, Sachin S. Goel, Molly I. Szerlip, Michael J. Mack, Mateo Marin-Cuartas, Siamak Mohammadi, Tamim M. Nazif, Axel Unbehaun, Martin Andreas, Derek R. Brinster, Newell B. Robinson, Lin Wang, Basel Ramlawi, Lenard Conradi, Nimesh D. Desai, John K. Forrest, Rodrigo Bagur, Tom C. NguyenRon Waksman, Lionel Leroux, Eric Van Belle, Kendra J. Grubb, Hasan A. Ahmad, Paolo Denti, Thomas Modine, Vinayak N. Bapat, Tsuyoshi Kaneko, Michael J. Reardon, Gilbert H.L. Tang, Giuseppe Bruschi, Katherine B. Harrington, John J. Squiers, J. Michael DiMaio, Sameer Hirji, Pinak B. Shah, Flavien Vincent, Mohammad Koussa, Isaac George, Nicholas M. Van Mieghem, Thijmen W. Hokken, Joerg Kempfert, Keti Vitanova, Rudiger Lange, Marvin D. Atkins, John R. Doty, Brian K. Whisenant, Andrea Garatti, Marco Di Eusanio, Filippo Capestro, Philipp Kiefer, David Holzhey, Thilo Noack, Michael A. Borger, Luigi Pirelli, Shekhar Saha, Christian Hagl, Muhanad Algadheeb, Michael W.A. Chu, Antonio Di Virgilio, Michael H. Salinger, Paul Werner, Christian Shults, Lowell F. Satler, Walid Ben Ali, Philippe Demers, Reda Ibrahim, Joshua Rovin, Pierre Voisine, Josep Rodés-Cabau, Guido Gelpi, Igor Belluschi, Francesco Maisano, George A. Petrossian, Maral Ouzounian, Oliver D. Bhadra, Rodrigo Estevez-Loureiro, Miguel A. Pinon, Moritz Wyler von Ballmoos, Shinichi Fukuhara, G. Michael Deeb, Marc Ruel, Talal Al-Atassi, Augusto D'Onofrio, Chiara Tessari, Joseph E. Bavaria, Andrea Colli, Alejandro Pizano, Kashish Goel, Ashish S. Shah, Joshua B. Goldberg, Arnar Geirsson, Maurizio Taramasso, Marco Gennari

Research output: Contribution to journal › Article › peer-review

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Abstract

BACKGROUND: There are limited data on the impact of transcatheter heart valve (THV) type on the outcomes of surgical explantation after THV failure. AIMS: We sought to determine the outcomes of transcatheter aortic valve replacement (TAVR) explantation for failed balloon-expandable valves (BEV) versus self-expanding valves (SEV). METHODS: From November 2009 to February 2022, 401 patients across 42 centres in the EXPLANT-TAVR registry underwent TAVR explantation during a separate admission from the initial TAVR. Mechanically expandable valves (N=10, 2.5%) were excluded. The outcomes of TAVR explantation were compared for 202 (51.7%) failed BEV and 189 (48.3%) failed SEV. RESULTS: Among 391 patients analysed (mean age: 73.0±9.8 years; 33.8% female), the median time from index TAVR to TAVR explantation was 13.3 months (interquartile range 5.1-34.8), with no differences between groups. Indications for TAVR explantation included endocarditis (36.0% failed SEV vs 55.4% failed BEV; p<0.001), paravalvular leak (21.2% vs 11.9%; p=0.014), structural valve deterioration (30.2% vs 21.8%; p=0.065) and prosthesis-patient mismatch (8.5% vs 10.4%; p=0.61). The SEV group trended fewer urgent/emergency surgeries (52.0% vs 62.3%; p=0.057) and more root replacement (15.3% vs 7.4%; p=0.016). Concomitant cardiac procedures were performed in 57.8% of patients, including coronary artery bypass graft (24.8%), and mitral (38.9%) and tricuspid (14.6%) valve surgery, with no differences between groups. In-hospital, 30-day, and 1-year mortality and stroke rates were similar between groups (all p>0.05), with no differences in cumulative mortality at 3 years (log-rank p=0.95). On multivariable analysis, concomitant mitral surgery was an independent predictor of 1-year mortality after BEV explant (hazard ratio [HR] 2.00, 95% confidence interval [CI]: 1.07-3.72) and SEV explant (HR 2.00, 95% CI: 1.08-3.69). CONCLUSIONS: In the EXPLANT-TAVR global registry, BEV and SEV groups had different indications for surgical explantation, with more root replacements in SEV failure, but no differences in midterm mortality and morbidities. Further refinement of TAVR explantation techniques are important to improving outcomes.

Original language	English
Pages (from-to)	E146-E157
Journal	EuroIntervention
Volume	20
Issue number	2
DOIs	https://doi.org/10.4244/EIJ-D-23-00722
State	Published - Jan 2024

Keywords

TAVI
aortic stenosis
degenerative valve

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10.4244/EIJ-D-23-00722

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the EXPLANT-TAVR registry investigators, Zaid, S., Kleiman, N. S., Goel, S. S., Szerlip, M. I., Mack, M. J., Marin-Cuartas, M., Mohammadi, S., Nazif, T. M., Unbehaun, A., Andreas, M., Brinster, D. R., Robinson, N. B., Wang, L., Ramlawi, B., Conradi, L., Desai, N. D., Forrest, J. K., Bagur, R., ... Gennari, M. (2024). Impact of transcatheter heart valve type on outcomes of surgical explantation after failed transcatheter aortic valve replacement: the EXPLANT-TAVR international registry. EuroIntervention, 20(2), E146-E157. https://doi.org/10.4244/EIJ-D-23-00722

@article{14ee745836864780bec7a6573f5ac498,

title = "Impact of transcatheter heart valve type on outcomes of surgical explantation after failed transcatheter aortic valve replacement: the EXPLANT-TAVR international registry",

abstract = "BACKGROUND: There are limited data on the impact of transcatheter heart valve (THV) type on the outcomes of surgical explantation after THV failure. AIMS: We sought to determine the outcomes of transcatheter aortic valve replacement (TAVR) explantation for failed balloon-expandable valves (BEV) versus self-expanding valves (SEV). METHODS: From November 2009 to February 2022, 401 patients across 42 centres in the EXPLANT-TAVR registry underwent TAVR explantation during a separate admission from the initial TAVR. Mechanically expandable valves (N=10, 2.5%) were excluded. The outcomes of TAVR explantation were compared for 202 (51.7%) failed BEV and 189 (48.3%) failed SEV. RESULTS: Among 391 patients analysed (mean age: 73.0±9.8 years; 33.8% female), the median time from index TAVR to TAVR explantation was 13.3 months (interquartile range 5.1-34.8), with no differences between groups. Indications for TAVR explantation included endocarditis (36.0% failed SEV vs 55.4% failed BEV; p<0.001), paravalvular leak (21.2% vs 11.9%; p=0.014), structural valve deterioration (30.2% vs 21.8%; p=0.065) and prosthesis-patient mismatch (8.5% vs 10.4%; p=0.61). The SEV group trended fewer urgent/emergency surgeries (52.0% vs 62.3%; p=0.057) and more root replacement (15.3% vs 7.4%; p=0.016). Concomitant cardiac procedures were performed in 57.8% of patients, including coronary artery bypass graft (24.8%), and mitral (38.9%) and tricuspid (14.6%) valve surgery, with no differences between groups. In-hospital, 30-day, and 1-year mortality and stroke rates were similar between groups (all p>0.05), with no differences in cumulative mortality at 3 years (log-rank p=0.95). On multivariable analysis, concomitant mitral surgery was an independent predictor of 1-year mortality after BEV explant (hazard ratio [HR] 2.00, 95% confidence interval [CI]: 1.07-3.72) and SEV explant (HR 2.00, 95% CI: 1.08-3.69). CONCLUSIONS: In the EXPLANT-TAVR global registry, BEV and SEV groups had different indications for surgical explantation, with more root replacements in SEV failure, but no differences in midterm mortality and morbidities. Further refinement of TAVR explantation techniques are important to improving outcomes.",

keywords = "TAVI, aortic stenosis, degenerative valve",

author = "{the EXPLANT-TAVR registry investigators} and Syed Zaid and Kleiman, {Neal S.} and Goel, {Sachin S.} and Szerlip, {Molly I.} and Mack, {Michael J.} and Mateo Marin-Cuartas and Siamak Mohammadi and Nazif, {Tamim M.} and Axel Unbehaun and Martin Andreas and Brinster, {Derek R.} and Robinson, {Newell B.} and Lin Wang and Basel Ramlawi and Lenard Conradi and Desai, {Nimesh D.} and Forrest, {John K.} and Rodrigo Bagur and Nguyen, {Tom C.} and Ron Waksman and Lionel Leroux and {Van Belle}, Eric and Grubb, {Kendra J.} and Ahmad, {Hasan A.} and Paolo Denti and Thomas Modine and Bapat, {Vinayak N.} and Tsuyoshi Kaneko and Reardon, {Michael J.} and Tang, {Gilbert H.L.} and Giuseppe Bruschi and Harrington, {Katherine B.} and Squiers, {John J.} and DiMaio, {J. Michael} and Sameer Hirji and Shah, {Pinak B.} and Flavien Vincent and Mohammad Koussa and Isaac George and {Van Mieghem}, {Nicholas M.} and Hokken, {Thijmen W.} and Joerg Kempfert and Keti Vitanova and Rudiger Lange and Atkins, {Marvin D.} and Doty, {John R.} and Whisenant, {Brian K.} and Andrea Garatti and {Di Eusanio}, Marco and Filippo Capestro and Philipp Kiefer and David Holzhey and Thilo Noack and Borger, {Michael A.} and Luigi Pirelli and Shekhar Saha and Christian Hagl and Muhanad Algadheeb and Chu, {Michael W.A.} and {Di Virgilio}, Antonio and Salinger, {Michael H.} and Paul Werner and Christian Shults and Satler, {Lowell F.} and Ali, {Walid Ben} and Philippe Demers and Reda Ibrahim and Joshua Rovin and Pierre Voisine and Josep Rod{\'e}s-Cabau and Guido Gelpi and Igor Belluschi and Francesco Maisano and Petrossian, {George A.} and Maral Ouzounian and Bhadra, {Oliver D.} and Rodrigo Estevez-Loureiro and Pinon, {Miguel A.} and {von Ballmoos}, {Moritz Wyler} and Shinichi Fukuhara and Deeb, {G. Michael} and Marc Ruel and Talal Al-Atassi and Augusto D'Onofrio and Chiara Tessari and Bavaria, {Joseph E.} and Andrea Colli and Alejandro Pizano and Kashish Goel and Shah, {Ashish S.} and Goldberg, {Joshua B.} and Arnar Geirsson and Maurizio Taramasso and Marco Gennari",

year = "2024",

month = jan,

doi = "10.4244/EIJ-D-23-00722",

language = "English",

volume = "20",

pages = "E146--E157",

journal = "EuroIntervention",

issn = "1774-024X",

number = "2",

}

the EXPLANT-TAVR registry investigators, Zaid, S, Kleiman, NS, Goel, SS, Szerlip, MI, Mack, MJ, Marin-Cuartas, M, Mohammadi, S, Nazif, TM, Unbehaun, A, Andreas, M, Brinster, DR, Robinson, NB, Wang, L, Ramlawi, B, Conradi, L, Desai, ND, Forrest, JK, Bagur, R, Nguyen, TC, Waksman, R, Leroux, L, Van Belle, E, Grubb, KJ, Ahmad, HA, Denti, P, Modine, T, Bapat, VN, Kaneko, T, Reardon, MJ, Tang, GHL, Bruschi, G, Harrington, KB, Squiers, JJ, DiMaio, JM, Hirji, S, Shah, PB, Vincent, F, Koussa, M, George, I, Van Mieghem, NM, Hokken, TW, Kempfert, J, Vitanova, K, Lange, R, Atkins, MD, Doty, JR, Whisenant, BK, Garatti, A, Di Eusanio, M, Capestro, F, Kiefer, P, Holzhey, D, Noack, T, Borger, MA, Pirelli, L, Saha, S, Hagl, C, Algadheeb, M, Chu, MWA, Di Virgilio, A, Salinger, MH, Werner, P, Shults, C, Satler, LF, Ali, WB, Demers, P, Ibrahim, R, Rovin, J, Voisine, P, Rodés-Cabau, J, Gelpi, G, Belluschi, I, Maisano, F, Petrossian, GA, Ouzounian, M, Bhadra, OD, Estevez-Loureiro, R, Pinon, MA, von Ballmoos, MW, Fukuhara, S, Deeb, GM, Ruel, M, Al-Atassi, T, D'Onofrio, A, Tessari, C, Bavaria, JE, Colli, A, Pizano, A, Goel, K, Shah, AS, Goldberg, JB, Geirsson, A, Taramasso, M & Gennari, M 2024, 'Impact of transcatheter heart valve type on outcomes of surgical explantation after failed transcatheter aortic valve replacement: the EXPLANT-TAVR international registry', EuroIntervention, vol. 20, no. 2, pp. E146-E157. https://doi.org/10.4244/EIJ-D-23-00722

Impact of transcatheter heart valve type on outcomes of surgical explantation after failed transcatheter aortic valve replacement: the EXPLANT-TAVR international registry. / the EXPLANT-TAVR registry investigators; Zaid, Syed; Kleiman, Neal S. et al.
In: EuroIntervention, Vol. 20, No. 2, 01.2024, p. E146-E157.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Impact of transcatheter heart valve type on outcomes of surgical explantation after failed transcatheter aortic valve replacement

T2 - the EXPLANT-TAVR international registry

AU - the EXPLANT-TAVR registry investigators

AU - Zaid, Syed

AU - Kleiman, Neal S.

AU - Goel, Sachin S.

AU - Szerlip, Molly I.

AU - Mack, Michael J.

AU - Marin-Cuartas, Mateo

AU - Mohammadi, Siamak

AU - Nazif, Tamim M.

AU - Unbehaun, Axel

AU - Andreas, Martin

AU - Brinster, Derek R.

AU - Robinson, Newell B.

AU - Wang, Lin

AU - Ramlawi, Basel

AU - Conradi, Lenard

AU - Desai, Nimesh D.

AU - Forrest, John K.

AU - Bagur, Rodrigo

AU - Nguyen, Tom C.

AU - Waksman, Ron

AU - Leroux, Lionel

AU - Van Belle, Eric

AU - Grubb, Kendra J.

AU - Ahmad, Hasan A.

AU - Denti, Paolo

AU - Modine, Thomas

AU - Bapat, Vinayak N.

AU - Kaneko, Tsuyoshi

AU - Reardon, Michael J.

AU - Tang, Gilbert H.L.

AU - Bruschi, Giuseppe

AU - Harrington, Katherine B.

AU - Squiers, John J.

AU - DiMaio, J. Michael

AU - Hirji, Sameer

AU - Shah, Pinak B.

AU - Vincent, Flavien

AU - Koussa, Mohammad

AU - George, Isaac

AU - Van Mieghem, Nicholas M.

AU - Hokken, Thijmen W.

AU - Kempfert, Joerg

AU - Vitanova, Keti

AU - Lange, Rudiger

AU - Atkins, Marvin D.

AU - Doty, John R.

AU - Whisenant, Brian K.

AU - Garatti, Andrea

AU - Di Eusanio, Marco

AU - Capestro, Filippo

AU - Kiefer, Philipp

AU - Holzhey, David

AU - Noack, Thilo

AU - Borger, Michael A.

AU - Pirelli, Luigi

AU - Saha, Shekhar

AU - Hagl, Christian

AU - Algadheeb, Muhanad

AU - Chu, Michael W.A.

AU - Di Virgilio, Antonio

AU - Salinger, Michael H.

AU - Werner, Paul

AU - Shults, Christian

AU - Satler, Lowell F.

AU - Ali, Walid Ben

AU - Demers, Philippe

AU - Ibrahim, Reda

AU - Rovin, Joshua

AU - Voisine, Pierre

AU - Rodés-Cabau, Josep

AU - Gelpi, Guido

AU - Belluschi, Igor

AU - Maisano, Francesco

AU - Petrossian, George A.

AU - Ouzounian, Maral

AU - Bhadra, Oliver D.

AU - Estevez-Loureiro, Rodrigo

AU - Pinon, Miguel A.

AU - von Ballmoos, Moritz Wyler

AU - Fukuhara, Shinichi

AU - Deeb, G. Michael

AU - Ruel, Marc

AU - Al-Atassi, Talal

AU - D'Onofrio, Augusto

AU - Tessari, Chiara

AU - Bavaria, Joseph E.

AU - Colli, Andrea

AU - Pizano, Alejandro

AU - Goel, Kashish

AU - Shah, Ashish S.

AU - Goldberg, Joshua B.

AU - Geirsson, Arnar

AU - Taramasso, Maurizio

AU - Gennari, Marco

PY - 2024/1

Y1 - 2024/1

N2 - BACKGROUND: There are limited data on the impact of transcatheter heart valve (THV) type on the outcomes of surgical explantation after THV failure. AIMS: We sought to determine the outcomes of transcatheter aortic valve replacement (TAVR) explantation for failed balloon-expandable valves (BEV) versus self-expanding valves (SEV). METHODS: From November 2009 to February 2022, 401 patients across 42 centres in the EXPLANT-TAVR registry underwent TAVR explantation during a separate admission from the initial TAVR. Mechanically expandable valves (N=10, 2.5%) were excluded. The outcomes of TAVR explantation were compared for 202 (51.7%) failed BEV and 189 (48.3%) failed SEV. RESULTS: Among 391 patients analysed (mean age: 73.0±9.8 years; 33.8% female), the median time from index TAVR to TAVR explantation was 13.3 months (interquartile range 5.1-34.8), with no differences between groups. Indications for TAVR explantation included endocarditis (36.0% failed SEV vs 55.4% failed BEV; p<0.001), paravalvular leak (21.2% vs 11.9%; p=0.014), structural valve deterioration (30.2% vs 21.8%; p=0.065) and prosthesis-patient mismatch (8.5% vs 10.4%; p=0.61). The SEV group trended fewer urgent/emergency surgeries (52.0% vs 62.3%; p=0.057) and more root replacement (15.3% vs 7.4%; p=0.016). Concomitant cardiac procedures were performed in 57.8% of patients, including coronary artery bypass graft (24.8%), and mitral (38.9%) and tricuspid (14.6%) valve surgery, with no differences between groups. In-hospital, 30-day, and 1-year mortality and stroke rates were similar between groups (all p>0.05), with no differences in cumulative mortality at 3 years (log-rank p=0.95). On multivariable analysis, concomitant mitral surgery was an independent predictor of 1-year mortality after BEV explant (hazard ratio [HR] 2.00, 95% confidence interval [CI]: 1.07-3.72) and SEV explant (HR 2.00, 95% CI: 1.08-3.69). CONCLUSIONS: In the EXPLANT-TAVR global registry, BEV and SEV groups had different indications for surgical explantation, with more root replacements in SEV failure, but no differences in midterm mortality and morbidities. Further refinement of TAVR explantation techniques are important to improving outcomes.

AB - BACKGROUND: There are limited data on the impact of transcatheter heart valve (THV) type on the outcomes of surgical explantation after THV failure. AIMS: We sought to determine the outcomes of transcatheter aortic valve replacement (TAVR) explantation for failed balloon-expandable valves (BEV) versus self-expanding valves (SEV). METHODS: From November 2009 to February 2022, 401 patients across 42 centres in the EXPLANT-TAVR registry underwent TAVR explantation during a separate admission from the initial TAVR. Mechanically expandable valves (N=10, 2.5%) were excluded. The outcomes of TAVR explantation were compared for 202 (51.7%) failed BEV and 189 (48.3%) failed SEV. RESULTS: Among 391 patients analysed (mean age: 73.0±9.8 years; 33.8% female), the median time from index TAVR to TAVR explantation was 13.3 months (interquartile range 5.1-34.8), with no differences between groups. Indications for TAVR explantation included endocarditis (36.0% failed SEV vs 55.4% failed BEV; p<0.001), paravalvular leak (21.2% vs 11.9%; p=0.014), structural valve deterioration (30.2% vs 21.8%; p=0.065) and prosthesis-patient mismatch (8.5% vs 10.4%; p=0.61). The SEV group trended fewer urgent/emergency surgeries (52.0% vs 62.3%; p=0.057) and more root replacement (15.3% vs 7.4%; p=0.016). Concomitant cardiac procedures were performed in 57.8% of patients, including coronary artery bypass graft (24.8%), and mitral (38.9%) and tricuspid (14.6%) valve surgery, with no differences between groups. In-hospital, 30-day, and 1-year mortality and stroke rates were similar between groups (all p>0.05), with no differences in cumulative mortality at 3 years (log-rank p=0.95). On multivariable analysis, concomitant mitral surgery was an independent predictor of 1-year mortality after BEV explant (hazard ratio [HR] 2.00, 95% confidence interval [CI]: 1.07-3.72) and SEV explant (HR 2.00, 95% CI: 1.08-3.69). CONCLUSIONS: In the EXPLANT-TAVR global registry, BEV and SEV groups had different indications for surgical explantation, with more root replacements in SEV failure, but no differences in midterm mortality and morbidities. Further refinement of TAVR explantation techniques are important to improving outcomes.

KW - TAVI

KW - aortic stenosis

KW - degenerative valve

UR - http://www.scopus.com/inward/record.url?scp=85182541197&partnerID=8YFLogxK

U2 - 10.4244/EIJ-D-23-00722

DO - 10.4244/EIJ-D-23-00722

M3 - Article

C2 - 38224255

AN - SCOPUS:85182541197

SN - 1774-024X

VL - 20

SP - E146-E157

JO - EuroIntervention

JF - EuroIntervention

IS - 2

ER -

Impact of transcatheter heart valve type on outcomes of surgical explantation after failed transcatheter aortic valve replacement: the EXPLANT-TAVR international registry

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