Surgical Explantation of Failed Transcatheter Aortic Valve Replacement.
Journal
The Annals of thoracic surgery
ISSN: 1552-6259
Titre abrégé: Ann Thorac Surg
Pays: Netherlands
ID NLM: 15030100R
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
received:
30
12
2022
revised:
10
05
2023
accepted:
30
05
2023
pubmed:
25
6
2023
medline:
25
6
2023
entrez:
24
6
2023
Statut:
ppublish
Résumé
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. 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. 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). 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 37354965
pii: S0003-4975(23)00612-4
doi: 10.1016/j.athoracsur.2023.05.036
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
933-942Investigateurs
Shekhar Saha
(S)
Philipp Kiefer
(P)
David Holzhey
(D)
Thilo Noack
(T)
Pierre Voisine
(P)
Siamak Mohammadi
(S)
Katherine B Harrington
(KB)
John J Squiers
(JJ)
Shinichi Fukuhara
(S)
Moritz Wyler von Ballmoos
(MW)
Sachin S Goel
(SS)
Marvin D Atkins
(MD)
Oliver D Bhadra
(OD)
Lenard Conradi
(L)
Christian Shults
(C)
Lowell F Satler
(LF)
Luigi Pirelli
(L)
Derek R Brinster
(DR)
Muhanad Algadheeb
(M)
Michael W A Chu
(MWA)
Rodrigo Bagur
(R)
Basel Ramlawi
(B)
Kendra J Grubb
(KJ)
Nimesh D Desai
(ND)
Newell B Robinson
(NB)
Lin Wang
(L)
George A Petrossian
(GA)
Lionel Leroux
(L)
John R Doty
(JR)
Joerg Kempfert
(J)
Axel Unbehaun
(A)
Hussein Rahim
(H)
Arnar Geirsson
(A)
John K Forrest
(JK)
Flavien Vincent
(F)
Eric Van Belle
(E)
Mohamad Koussa
(M)
Joshua B Goldberg
(JB)
Hasan A Ahmad
(HA)
Walid Ben Ali
(W)
Philippe Demers
(P)
Reda Ibrahim
(R)
Martin Andreas
(M)
Paul Werner
(P)
Kashish Goel
(K)
Ashish S Shah
(AS)
Guido Gelpi
(G)
Marc Ruel
(M)
Talal Al-Atassi
(T)
Nicholas M Van Mieghem
(NM)
Thijmen W Hokken
(TW)
Augusto D'Onofrio
(A)
Chiara Tessari
(C)
Pinak B Shah
(PB)
Igor Belluschi
(I)
Andrea Garatti
(A)
Giuseppe Bruschi
(G)
Maral Ouzounian
(M)
Alejandro Pizano
(A)
Marco Di Eusanio
(M)
Filippo Capestro
(F)
Joshua Rovin
(J)
Maurizio Taramasso
(M)
Marco Gennari
(M)
Andrea Colli
(A)
Rodrigo Estevez-Loureiro
(R)
Miguel A Pinon
(MA)
Michael H Salinger
(MH)
Antonio Di Virgilio
(A)
Brian K Whisenant
(BK)
Tamim M Nazif
(TM)
Neal S Kleiman
(NS)
Molly I Szerlip
(MI)
Ron Waksman
(R)
Josep Rodés-Cabau
(J)
Isaac George
(I)
J Michael DiMaio
(JM)
Francesco Maisano
(F)
G Michael Deeb
(GM)
Keti Vitanova
(K)
Rudiger Lange
(R)
Michael A Borger
(MA)
Christian Hagl
(C)
Joseph E Bavaria
(JE)
Informations de copyright
Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.