Surgical Explantation of Failed Transcatheter Aortic Valve Replacement

Syed Zaid; Sameer A. Hirji; EXPLANT-TAVR Investigators; Vinayak N. Bapat; Paolo Denti; Thomas Modine; Tom C. Nguyen; Michael J. Mack; Michael J. Reardon; Tsuyoshi Kaneko; Gilbert H.L. Tang; Shekhar Saha; Philipp Kiefer; David Holzhey; Thilo Noack; Pierre Voisine; Siamak Mohammadi; Katherine B. Harrington; John J. Squiers; Shinichi Fukuhara; Moritz Wyler von Ballmoos; Sachin S. Goel; Marvin D. Atkins; Oliver D. Bhadra; Lenard Conradi; Christian Shults; Lowell F. Satler; Luigi Pirelli; Derek R. Brinster; Muhanad Algadheeb; Michael W.A. Chu; Rodrigo Bagur; Basel Ramlawi; Kendra J. Grubb; Nimesh D. Desai; Newell B. Robinson; Lin Wang; George A. Petrossian; Lionel Leroux; John R. Doty; Joerg Kempfert; Axel Unbehaun; Hussein Rahim; Arnar Geirsson; John K. Forrest; Flavien Vincent; Eric Van Belle; Mohamad Koussa; Joshua B. Goldberg; Hasan A. Ahmad; Thijmen W. Hokken

doi:10.1016/j.athoracsur.2023.05.036

Surgical Explantation of Failed Transcatheter Aortic Valve Replacement

Syed Zaid, Sameer A. Hirji, EXPLANT-TAVR Investigators, Vinayak N. Bapat, Paolo Denti, Thomas Modine, Tom C. Nguyen, Michael J. Mack, Michael J. Reardon, Tsuyoshi Kaneko, Gilbert H.L. Tang^*, Shekhar Saha, Philipp Kiefer, David Holzhey, Thilo Noack, Pierre Voisine, Siamak Mohammadi, Katherine B. Harrington, John J. Squiers, Shinichi FukuharaMoritz Wyler von Ballmoos, Sachin S. Goel, Marvin D. Atkins, Oliver D. Bhadra, Lenard Conradi, Christian Shults, Lowell F. Satler, Luigi Pirelli, Derek R. Brinster, Muhanad Algadheeb, Michael W.A. Chu, Rodrigo Bagur, Basel Ramlawi, Kendra J. Grubb, Nimesh D. Desai, Newell B. Robinson, Lin Wang, George A. Petrossian, Lionel Leroux, John R. Doty, Joerg Kempfert, Axel Unbehaun, Hussein Rahim, Arnar Geirsson, John K. Forrest, Flavien Vincent, Eric Van Belle, Mohamad Koussa, Joshua B. Goldberg, Hasan A. Ahmad, Thijmen W. Hokken

^*Corresponding author for this work

Cardiology

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

15 Citations (Scopus)

Abstract

Background:

Recent reports have demonstrated worse than expected outcomes of surgical explantation after transcatheter aortic valve replacement (TAVR). However in-depth analysis of the short- and mid-term risk of concomitant cardiac surgery at the time of TAVR explant is lacking.

Methods:

Data from the multicenter EXPLANT-TAVR registry of patients undergoing TAVR-explant between November 2009 and September 2020 were retrospectively analyzed. Patients undergoing concomitant procedures were included, but explants performed during the same admission as the initial TAVR or concomitant procedures performed on the aortic root, ascending aorta, or arch were excluded. Outcomes were evaluated between the isolated surgical aortic valve replacement (SAVR) and concomitant SAVR groups. Median follow-up was 6.6 months.

Results:

Among 199 patients, concomitant SAVR was performed in 94 patients (47.2%), primarily with mitral valve surgery (n = 45) followed by coronary artery bypass grafting (n = 23). Despite similar mean ages between groups (72.8 vs 73.4 years), concomitant SAVR had a higher median Society of Thoracic Surgeons Predicted Risk of Mortality score at the index TAVR (5.9% vs 3.7%, P = .001). There were no differences in median time-to-explant between groups (12.9 vs 8.7 months, P = .78). However concomitant SAVR had longer mean cardiopulmonary bypass (166 vs 114 minutes, P = .001) and cross-clamp times (123 vs 81 minutes, P = .001). Both 30-day (16.7% vs 9.9%) and 1-year mortality (36.1% vs 22.1%) were higher with concomitant SAVR but did not reach statistical significance (both P > .05). On Kaplan-Meier analysis, actuarial estimates of cumulative survival were significantly lower with concomitant SAVR at 3 years (56.8% vs 81.1%, P = .020).

Conclusions:

For surgical explantation after TAVR failure, concomitant SAVR is associated with increased mortality. Further studies with longer follow-up are warranted to examine the benefit from earlier intervention before concomitant disease develops.

Original language	English
Pages (from-to)	933-942
Number of pages	10
Journal	Annals of Thoracic Surgery
Volume	116
Issue number	5
Early online date	22 Jun 2023
DOIs	https://doi.org/10.1016/j.athoracsur.2023.05.036
Publication status	Published - Nov 2023

Bibliographical note

Publisher Copyright:
© 2023 The Society of Thoracic Surgeons

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10.1016/j.athoracsur.2023.05.036

Cite this

Zaid, S., Hirji, S. A., EXPLANT-TAVR Investigators, Bapat, V. N., Denti, P., Modine, T., Nguyen, T. C., Mack, M. J., Reardon, M. J., Kaneko, T., Tang, G. H. L., Saha, S., Kiefer, P., Holzhey, D., Noack, T., Voisine, P., Mohammadi, S., Harrington, K. B., Squiers, J. J., ... Hokken, T. W. (2023). Surgical Explantation of Failed Transcatheter Aortic Valve Replacement. Annals of Thoracic Surgery, 116(5), 933-942. https://doi.org/10.1016/j.athoracsur.2023.05.036

@article{6ff09d6d15524b68a132570eb4461730,

title = "Surgical Explantation of Failed Transcatheter Aortic Valve Replacement",

abstract = "Background: Recent reports have demonstrated worse than expected outcomes of surgical explantation after transcatheter aortic valve replacement (TAVR). However in-depth analysis of the short- and mid-term risk of concomitant cardiac surgery at the time of TAVR explant is lacking. Methods:Data from the multicenter EXPLANT-TAVR registry of patients undergoing TAVR-explant between November 2009 and September 2020 were retrospectively analyzed. Patients undergoing concomitant procedures were included, but explants performed during the same admission as the initial TAVR or concomitant procedures performed on the aortic root, ascending aorta, or arch were excluded. Outcomes were evaluated between the isolated surgical aortic valve replacement (SAVR) and concomitant SAVR groups. Median follow-up was 6.6 months. Results: Among 199 patients, concomitant SAVR was performed in 94 patients (47.2%), primarily with mitral valve surgery (n = 45) followed by coronary artery bypass grafting (n = 23). Despite similar mean ages between groups (72.8 vs 73.4 years), concomitant SAVR had a higher median Society of Thoracic Surgeons Predicted Risk of Mortality score at the index TAVR (5.9% vs 3.7%, P = .001). There were no differences in median time-to-explant between groups (12.9 vs 8.7 months, P = .78). However concomitant SAVR had longer mean cardiopulmonary bypass (166 vs 114 minutes, P = .001) and cross-clamp times (123 vs 81 minutes, P = .001). Both 30-day (16.7% vs 9.9%) and 1-year mortality (36.1% vs 22.1%) were higher with concomitant SAVR but did not reach statistical significance (both P > .05). On Kaplan-Meier analysis, actuarial estimates of cumulative survival were significantly lower with concomitant SAVR at 3 years (56.8% vs 81.1%, P = .020). Conclusions: For surgical explantation after TAVR failure, concomitant SAVR is associated with increased mortality. Further studies with longer follow-up are warranted to examine the benefit from earlier intervention before concomitant disease develops.",

author = "Syed Zaid and Hirji, {Sameer A.} and {EXPLANT-TAVR Investigators} and Bapat, {Vinayak N.} and Paolo Denti and Thomas Modine and Nguyen, {Tom C.} and Mack, {Michael J.} and Reardon, {Michael J.} and Tsuyoshi Kaneko and Tang, {Gilbert H.L.} and Shekhar Saha and Philipp Kiefer and David Holzhey and Thilo Noack and Pierre Voisine and Siamak Mohammadi and Harrington, {Katherine B.} and Squiers, {John J.} and Shinichi Fukuhara and {von Ballmoos}, {Moritz Wyler} and Goel, {Sachin S.} and Atkins, {Marvin D.} and Bhadra, {Oliver D.} and Lenard Conradi and Christian Shults and Satler, {Lowell F.} and Luigi Pirelli and Brinster, {Derek R.} and Muhanad Algadheeb and Chu, {Michael W.A.} and Rodrigo Bagur and Basel Ramlawi and Grubb, {Kendra J.} and Desai, {Nimesh D.} and Robinson, {Newell B.} and Lin Wang and Petrossian, {George A.} and Lionel Leroux and Doty, {John R.} and Joerg Kempfert and Axel Unbehaun and Hussein Rahim and Arnar Geirsson and Forrest, {John K.} and Flavien Vincent and {Van Belle}, Eric and Mohamad Koussa and Goldberg, {Joshua B.} and Ahmad, {Hasan A.} and Hokken, {Thijmen W.}",

note = "Publisher Copyright: {\textcopyright} 2023 The Society of Thoracic Surgeons",

year = "2023",

month = nov,

doi = "10.1016/j.athoracsur.2023.05.036",

language = "English",

volume = "116",

pages = "933--942",

journal = "Annals of Thoracic Surgery",

issn = "0003-4975",

publisher = "Elsevier Inc.",

number = "5",

}

Zaid, S, Hirji, SA, EXPLANT-TAVR Investigators, Bapat, VN, Denti, P, Modine, T, Nguyen, TC, Mack, MJ, Reardon, MJ, Kaneko, T, Tang, GHL, Saha, S, Kiefer, P, Holzhey, D, Noack, T, Voisine, P, Mohammadi, S, Harrington, KB, Squiers, JJ, Fukuhara, S, von Ballmoos, MW, Goel, SS, Atkins, MD, Bhadra, OD, Conradi, L, Shults, C, Satler, LF, Pirelli, L, Brinster, DR, Algadheeb, M, Chu, MWA, Bagur, R, Ramlawi, B, Grubb, KJ, Desai, ND, Robinson, NB, Wang, L, Petrossian, GA, Leroux, L, Doty, JR, Kempfert, J, Unbehaun, A, Rahim, H, Geirsson, A, Forrest, JK, Vincent, F, Van Belle, E, Koussa, M, Goldberg, JB, Ahmad, HA & Hokken, TW 2023, 'Surgical Explantation of Failed Transcatheter Aortic Valve Replacement', Annals of Thoracic Surgery, vol. 116, no. 5, pp. 933-942. https://doi.org/10.1016/j.athoracsur.2023.05.036

TY - JOUR

T1 - Surgical Explantation of Failed Transcatheter Aortic Valve Replacement

AU - Zaid, Syed

AU - Hirji, Sameer A.

AU - EXPLANT-TAVR Investigators

AU - Bapat, Vinayak N.

AU - Denti, Paolo

AU - Modine, Thomas

AU - Nguyen, Tom C.

AU - Mack, Michael J.

AU - Reardon, Michael J.

AU - Kaneko, Tsuyoshi

AU - Tang, Gilbert H.L.

AU - Saha, Shekhar

AU - Kiefer, Philipp

AU - Holzhey, David

AU - Noack, Thilo

AU - Voisine, Pierre

AU - Mohammadi, Siamak

AU - Harrington, Katherine B.

AU - Squiers, John J.

AU - Fukuhara, Shinichi

AU - von Ballmoos, Moritz Wyler

AU - Goel, Sachin S.

AU - Atkins, Marvin D.

AU - Bhadra, Oliver D.

AU - Conradi, Lenard

AU - Shults, Christian

AU - Satler, Lowell F.

AU - Pirelli, Luigi

AU - Brinster, Derek R.

AU - Algadheeb, Muhanad

AU - Chu, Michael W.A.

AU - Bagur, Rodrigo

AU - Ramlawi, Basel

AU - Grubb, Kendra J.

AU - Desai, Nimesh D.

AU - Robinson, Newell B.

AU - Wang, Lin

AU - Petrossian, George A.

AU - Leroux, Lionel

AU - Doty, John R.

AU - Kempfert, Joerg

AU - Unbehaun, Axel

AU - Rahim, Hussein

AU - Geirsson, Arnar

AU - Forrest, John K.

AU - Vincent, Flavien

AU - Van Belle, Eric

AU - Koussa, Mohamad

AU - Goldberg, Joshua B.

AU - Ahmad, Hasan A.

AU - Hokken, Thijmen W.

PY - 2023/11

Y1 - 2023/11

N2 - Background: Recent reports have demonstrated worse than expected outcomes of surgical explantation after transcatheter aortic valve replacement (TAVR). However in-depth analysis of the short- and mid-term risk of concomitant cardiac surgery at the time of TAVR explant is lacking. Methods:Data from the multicenter EXPLANT-TAVR registry of patients undergoing TAVR-explant between November 2009 and September 2020 were retrospectively analyzed. Patients undergoing concomitant procedures were included, but explants performed during the same admission as the initial TAVR or concomitant procedures performed on the aortic root, ascending aorta, or arch were excluded. Outcomes were evaluated between the isolated surgical aortic valve replacement (SAVR) and concomitant SAVR groups. Median follow-up was 6.6 months. Results: Among 199 patients, concomitant SAVR was performed in 94 patients (47.2%), primarily with mitral valve surgery (n = 45) followed by coronary artery bypass grafting (n = 23). Despite similar mean ages between groups (72.8 vs 73.4 years), concomitant SAVR had a higher median Society of Thoracic Surgeons Predicted Risk of Mortality score at the index TAVR (5.9% vs 3.7%, P = .001). There were no differences in median time-to-explant between groups (12.9 vs 8.7 months, P = .78). However concomitant SAVR had longer mean cardiopulmonary bypass (166 vs 114 minutes, P = .001) and cross-clamp times (123 vs 81 minutes, P = .001). Both 30-day (16.7% vs 9.9%) and 1-year mortality (36.1% vs 22.1%) were higher with concomitant SAVR but did not reach statistical significance (both P > .05). On Kaplan-Meier analysis, actuarial estimates of cumulative survival were significantly lower with concomitant SAVR at 3 years (56.8% vs 81.1%, P = .020). Conclusions: For surgical explantation after TAVR failure, concomitant SAVR is associated with increased mortality. Further studies with longer follow-up are warranted to examine the benefit from earlier intervention before concomitant disease develops.

AB - Background: Recent reports have demonstrated worse than expected outcomes of surgical explantation after transcatheter aortic valve replacement (TAVR). However in-depth analysis of the short- and mid-term risk of concomitant cardiac surgery at the time of TAVR explant is lacking. Methods:Data from the multicenter EXPLANT-TAVR registry of patients undergoing TAVR-explant between November 2009 and September 2020 were retrospectively analyzed. Patients undergoing concomitant procedures were included, but explants performed during the same admission as the initial TAVR or concomitant procedures performed on the aortic root, ascending aorta, or arch were excluded. Outcomes were evaluated between the isolated surgical aortic valve replacement (SAVR) and concomitant SAVR groups. Median follow-up was 6.6 months. Results: Among 199 patients, concomitant SAVR was performed in 94 patients (47.2%), primarily with mitral valve surgery (n = 45) followed by coronary artery bypass grafting (n = 23). Despite similar mean ages between groups (72.8 vs 73.4 years), concomitant SAVR had a higher median Society of Thoracic Surgeons Predicted Risk of Mortality score at the index TAVR (5.9% vs 3.7%, P = .001). There were no differences in median time-to-explant between groups (12.9 vs 8.7 months, P = .78). However concomitant SAVR had longer mean cardiopulmonary bypass (166 vs 114 minutes, P = .001) and cross-clamp times (123 vs 81 minutes, P = .001). Both 30-day (16.7% vs 9.9%) and 1-year mortality (36.1% vs 22.1%) were higher with concomitant SAVR but did not reach statistical significance (both P > .05). On Kaplan-Meier analysis, actuarial estimates of cumulative survival were significantly lower with concomitant SAVR at 3 years (56.8% vs 81.1%, P = .020). Conclusions: For surgical explantation after TAVR failure, concomitant SAVR is associated with increased mortality. Further studies with longer follow-up are warranted to examine the benefit from earlier intervention before concomitant disease develops.

UR - http://www.scopus.com/inward/record.url?scp=85169788567&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2023.05.036

DO - 10.1016/j.athoracsur.2023.05.036

M3 - Article

C2 - 37354965

AN - SCOPUS:85169788567

SN - 0003-4975

VL - 116

SP - 933

EP - 942

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

IS - 5

ER -

Surgical Explantation of Failed Transcatheter Aortic Valve Replacement

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