Outcome after Surgical TAVR Explantation: Insights from the International Multicenter EXPLANT-TAVR Registry

Background: Low-risk patients with severe aortic stenosis (AS) will be increasingly treated with TAVI (transcatheter aortic valve implantation) in the future. Therefore, it can be expected that surgical TAVI explantation may become increasingly necessary due to degeneration, leakage or endocarditis. Little is known about surgical explantation of TAVI devices, failure mechanisms and outcomes after surgery. Aim of this study was to evaluate the clinical and echocardiographic outcomes after surgical TAVI explantation.

Method: The EXPLANT-TAVR is an international, retrospective registry including 269 patients who underwent surgical TAVR explantation. Median follow-up duration was 6.7 months after TAVR explantation and was 97.7% complete at 30 days and 86.1% complete at 1 year. Explantations performed during the same admission as initial TAVR were excluded.

Results: From November 2009 to September 2020, a total of 269 patients across 42 centers with a mean age of 72.7 ± 10.4 years underwent TAVR explantation. About one quarter (25.9%) were deemed low surgical risk at index TAVR, and median Society of Thoracic Surgeons risk at TAVR explantation was 5.6% (IQR: 3.2–9.6%). The median time to explantation was 11.5 months (IQR: 4.0–32.4 months). Balloon-expandable and self-expanding or mechanically expandable valves accounted for 50.9 and 49.1%, respectively. Indications for explantation included endocarditis (43.1%), structural valve degeneration (20.1%), paravalvular leak (18.2%), and prosthesis-patient mismatch (10.8%).

Redo TAVI was not feasible because of unfavorable anatomy in 26.8% of patients. Urgent or emergency cases were performed in 53.1% of patients, aortic root replacement in 13.4%, and 54.6% had concomitant cardiac procedures. Overall survival at last follow-up was 76.1%. In-hospital, 30-day, and 1-year mortality rates were 11.9, 13.1, and 28.5%, respectively, and stroke rates were 5.9, 8.6, and 18.7%, respectively.

Conclusion: The EXPLANT-TAVR international registry represents the largest retrospective experience in surgical explantation of TAVI devices. Findings may guide decision-making in TAVI vs. SAVR as index intervention as part of patient lifetime management strategy. The EXPLANT-TAVR registry reveals that surgical risks associated with TAVI explantation are not negligible and should be taken into consideration in the lifetime management of AS.

Publication History

Article published online:
03 February 2022