Details

Autor(en) / Beteiligte

• 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, Thomas
• Corona, Silvia
• Wang, Lin
• Petrossian, George
• Robinson, Newell
• Meier, David
• Webb, John G
• Cheung, Anson
• Ramlawi, Basel
• Herrmann, Howard C
• Desai, Nimesh D
• Andreas, Martin
• Mach, Markus
• Waksman, Ron
• Schults, Christian C
• Ahmad, Hasan
• Goldberg, Joshua B
• Geirsson, Arnar
• Forrest, John K
• Denti, Paolo
• Belluschi, Igor
• Ben-Ali, Walid
• Asgar, Anita W
• Taramasso, Maurizio
• Rovin, Joshua D
• Di Eusanio, Marco
• Colli, Andrea
• Kaneko, Tsuyoshi
• Nazif, Tamim N
• Leon, Martin B
• Bapat, Vinayak N
• Mack, Michael J
• Reardon, Michael J
• Sathananthan, Janarthanan

Titel

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

Ist Teil von

• JACC. Cardiovascular interventions, 2023-04, Vol.16 (8), p.927-941

Ort / Verlag

United States

Erscheinungsjahr

2023

Quelle

Free E-Journal (出版社公開部分のみ）

Beschreibungen/Notizen

• Valve reintervention after transcatheter aortic valve replacement (TAVR) failure has not been studied in detail. The authors sought to determine outcomes of TAVR surgical explantation (TAVR-explant) vs redo-TAVR because they are largely unknown. 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. 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). 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.