New Research PaperStructuralExplant vs Redo-TAVR After Transcatheter Valve Failure: Mid-Term Outcomes From the EXPLANTORREDO-TAVR International Registry
Central Illustration
Section snippets
Data Source
The EXPLANTORREDO-TAVR registry is a multicenter, international registry of patients who underwent TAVR-explant or redo-TAVR for THV failure. This registry included 29 centers performing both surgical and transcatheter reintervention for THV failure, between May 2009 and February 2022. Initial TAVR was performed between June 2007 and November 2021, and was not limited to only our participating centers, given a proportion of patients who underwent reintervention at our centers had TAVR at
Baseline Clinical Characteristics at Index TAVR
Among 66,760 patients undergoing TAVR at the sites participating in the EXPLANTORREDO-TAVR registry during the study period, a total of 396 (0.59%) patients underwent reintervention for THV failure, per the inclusion criteria. Baseline clinical characteristics at the index-TAVR procedure are summarized in Table 1. Mean age was 75.5 ± 9.3 years, 40.9% were female, and 14.3% of patients were deemed low surgical risk by the local heart team. At index-TAVR, 38.4% of patients had previous cardiac
Discussion
This multicenter, international EXPLANTORREDO-TAVR registry is the first study to report the incidence, characteristics, and mid-term outcomes of TAVR-explant and redo-TAVR across the same centers. This is the largest and most comprehensive in-depth evaluation to date comparing the 2 treatment strategies for THV failure. The incidence of AV reintervention after THV failure was 0.59%. Our study has several key findings (Central Illustration): First, the incidence of reintervention after THV
Conclusions
This first report of the multicenter, international EXPLANTORREDO-TAVR registry provides a timely longitudinal review of the incidence, characteristics, and mid-term outcomes of redo-TAVR vs TAVR-explant across the same centers. Although TAVR-explant was riskier, with earlier reintervention and higher 30-day mortality, long-term prognosis remained similar to redo-TAVR patients. Our study provides valuable insights on lifetime management of patients with THV failure, and for further research to
Funding Support and Author Disclosures
Dr Meier is supported by the Swiss National Science Foundation (grant P2LAP3_199561). Dr Tang has been a proctor for Medtronic; a consultant for Medtronic and Abbott Structural Heart; and an advisory board member for Abbott Structural Heart and JenaValve. Dr Kleiman has been a local principal investigator in trials sponsored by Boston Scientific, Medtronic, Abbott, and Edwards Lifesciences. Dr Fukuhara has been a consultant for Medtronic, Artiviion, and Terumo Aortic. Dr Mohamed Abdel-Wahab has
Acknowledgments
The authors thank all the coinvestigators for their participation and involvement in the EXPLANTORREDO-TAVR registry.
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Drs Tang and Zaid contributed equally to this work.