Transcatheter heart valve explant with infective endocarditis-associated prosthesis failure and outcomes: the EXPLANT-TAVR international registry.

Bioprosthetic valve dysfunction Endocarditis Surgical aortic valve replacement TAVR explantation THV failure Transcatheter aortic valve replacement

Journal

European heart journal

ISSN: 1522-9645

Titre abrégé: Eur Heart J

Pays: England

ID NLM: 8006263

Informations de publication

Date de publication:
31 May 2024

Historique:

received: 23 09 2023

revised: 10 04 2024

accepted: 29 04 2024

medline: 31 5 2024

pubmed: 31 5 2024

entrez: 31 5 2024

Statut: aheadofprint

Résumé

Surgical explantation of transcatheter heart valves (THVs) is rapidly increasing, but there are limited data on patients with THV-associated infective endocarditis (IE). This study aims to assess the outcomes of patients undergoing THV explant for IE. All patients who underwent THV explant between 2011 and 2022 from 44 sites in the EXPLANT-TAVR registry were identified. Patients with IE as the reason for THV explant were compared to those with other mechanisms of bioprosthetic valve dysfunction (BVD). A total of 372 patients from the EXPLANT-TAVR registry were included. Among them, 184 (49.5%) patients underwent THV explant due to IE and 188 (50.5%) patients due to BVD. At the index transcatheter aortic valve replacement, patients undergoing THV explant for IE were older (74.3 ± 8.6 vs. 71 ± 10.6 years) and had a lower Society of Thoracic Surgeons risk score [2.6% (1.8-5.0) vs. 3.3% (2.1-5.6), P = .029] compared to patients with BVD. Compared to BVD, IE patients had longer intensive care unit and hospital stays (P < .05) and higher stroke rates at 30 days (8.6% vs. 2.9%, P = .032) and 1 year (16.2% vs. 5.2%, P = .010). Adjusted in-hospital, 30-day, and 1-year mortality was 12.1%, 16.1%, and 33.8%, respectively, for the entire cohort, with no significant differences between groups. Although mortality was numerically higher in IE patients 3 years postsurgery (29.6% for BVD vs. 43.9% for IE), Kaplan-Meier analysis showed no significant differences between groups (P = .16). In the EXPLANT-TAVR registry, patients undergoing THV explant for IE had higher 30-day and 1-year stroke rates and longer intensive care unit and hospital stays. Moreover, patients undergoing THV explant for IE had a higher 3-year mortality rate, which did not reach statistical significance given the relatively small sample size of this unique cohort and the reduced number of events.

Sections du résumé

BACKGROUND AND AIMS OBJECTIVE

METHODS METHODS

All patients who underwent THV explant between 2011 and 2022 from 44 sites in the EXPLANT-TAVR registry were identified. Patients with IE as the reason for THV explant were compared to those with other mechanisms of bioprosthetic valve dysfunction (BVD).

RESULTS RESULTS

A total of 372 patients from the EXPLANT-TAVR registry were included. Among them, 184 (49.5%) patients underwent THV explant due to IE and 188 (50.5%) patients due to BVD. At the index transcatheter aortic valve replacement, patients undergoing THV explant for IE were older (74.3 ± 8.6 vs. 71 ± 10.6 years) and had a lower Society of Thoracic Surgeons risk score [2.6% (1.8-5.0) vs. 3.3% (2.1-5.6), P = .029] compared to patients with BVD. Compared to BVD, IE patients had longer intensive care unit and hospital stays (P < .05) and higher stroke rates at 30 days (8.6% vs. 2.9%, P = .032) and 1 year (16.2% vs. 5.2%, P = .010). Adjusted in-hospital, 30-day, and 1-year mortality was 12.1%, 16.1%, and 33.8%, respectively, for the entire cohort, with no significant differences between groups. Although mortality was numerically higher in IE patients 3 years postsurgery (29.6% for BVD vs. 43.9% for IE), Kaplan-Meier analysis showed no significant differences between groups (P = .16).

CONCLUSIONS CONCLUSIONS

In the EXPLANT-TAVR registry, patients undergoing THV explant for IE had higher 30-day and 1-year stroke rates and longer intensive care unit and hospital stays. Moreover, patients undergoing THV explant for IE had a higher 3-year mortality rate, which did not reach statistical significance given the relatively small sample size of this unique cohort and the reduced number of events.

Identifiants

DOI: 10.1093/eurheartj/ehae292 PMID: 38820201

pubmed: 38820201

pii: 7686074

doi: 10.1093/eurheartj/ehae292

pii:

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Investigateurs

Giuseppe Bruschi (G)

John J Squiers (JJ)

Molly I Szerlip (MI)

J Michael DiMaio (JM)

Sameer Hirji (S)

Pinak B Shah (PB)

Lionel Leroux (L)

Eric Van Belle (E)

Mohammad Koussa (M)

Tamim M Nazif (TM)

Isaac George (I)

Nicholas M Van Mieghem (NM)

Thijmen W Hokken (TW)

Axel Unbehaun (A)

Keti Vitanova (K)

Marvin D Atkins (MD)

John R Doty (JR)

Brian K Whisenant (BK)

Marco Di Eusanio (M)

Filippo Capestro (F)

Basel Ramlawi (B)

David Holzhey (D)

Thilo Noack (T)

Luigi Pirelli (L)

Derek R Brinster (DR)

Muhanad Algadheeb (M)

Rodrigo Bagur (R)

Antonio Di Virgilio (A)

Michael H Salinger (MH)

Martin Andreas (M)

Lowell F Satler (LF)

Ron Waksman (R)

Walid Ben Ali (WB)

Reda Ibrahim (R)

Philippe Demers (P)

Joshua Rovin (J)

Pierre Voisine (P)

Siamak Mohammadi (S)

Josep Rodés-Cabau (J)

Guido Gelpi (G)

Igor Belluschi (I)

Francesco Maisano (F)

Newell B Robinson (NB)

Lin Wang (L)

Maral Ouzounian (M)

Lenard Conradi (L)

Rodrigo Estevez-Loureiro (R)

Miguel A Pinon (MA)

Moritz Wyler von Ballmoos (M)

Tom C Nguyen (TC)

G Michael Deeb (GM)

Marc Ruel (M)

Talal Al-Atassi (T)

Augusto D'Onofrio (A)

Chiara Tessari (C)

Joseph E Bavaria (JE)

Andrea Colli (A)

Alejandro Pizano (A)

Kashish Goel (K)

Ashish S Shah (AS)

Hasan A Ahmad (HA)

John K Forrest (JK)

Maurizio Taramasso (M)

Marco Gennari (M)

Informations de copyright

© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.