Key result
TAVR explantation carries ~20% 30-day mortality and frequently requires concomitant procedures.
Why the study?
TAVR explant is an essential treatment for late-stage BVF or PVE, but poor outcomes have been reported, prompting an assessment of outcomes at a high-volume Japanese center.
What are the clinical outcomes of TAVR explantation in patients with late-stage biological valve failure or prosthetic valve endocarditis?
Cohort (n=10)
No
What are the clinical outcomes of TAVR explantation in patients with late-stage biological valve failure or prosthetic valve endocarditis?
TAVR explantation is associated with high mortality and frequently requires concomitant procedures, highlighting the complexity and high risk of this emerging clinical scenario.
Background: Transcatheter aortic valve replacement (TAVR) explant is an essential therapeutic option for late-stage biological valve failure (BVF) or prosthetic valve endocarditis (PVE) following TAVR, though poor outcomes have been reported. This study assesses TAVR explant outcomes at a high-volume Japanese center. Methods: From October 2009 to December 2023, 10 TAVR explants were performed after 1,364 TAVR procedures at a leading Japanese high-volume center, and clinical outcomes were retrospectively analyzed. Data were drawn from a prospectively maintained database, assessing preoperative and intraoperative variables, as well as short- and long-term postoperative outcomes. Results: Thirty-nine BVFs were observed during follow-up, and 16 (41.0%) redo-TAVRs were performed in the same timeframe. In the 10 (25.6%) TAVR explant cases, the median age of the patients was 79.5 years, with a predicted mortality for isolated surgical aortic valve replacement (SAVR) by Society of Thoracic Surgeons (STS) score of 4.5%. The primary indications for TAVR explant were PVE (40.0%) and structural valve deterioration (SVD) (30.0%). Concomitant procedures were necessary in 90% of cases, including aortic repair (40.0%) and mitral replacement or repair (30.0%). Aortic annulus reinforcement using autologous pericardium was performed in 30% of cases. The 30-day mortality rate was 20%, with 20% of cases requiring temporary mechanical circulatory support and postoperative continuous hemodiafiltration. In mid-term outcomes, the survival rate was 60% in 1 year and 40% in 3 years, respectively. Conclusions: In this Japanese high-volume center experience, TAVR explants predominantly involved elderly patients and frequently required a concomitant procedure. The outcome was generally poor, comparable to those in Western countries. As the number of TAVR explants is expected to increase in Japan, knowledge-sharing within heart teams, including cardiac surgeons, is essential.
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Shimamura et al. (2025) conducted a cohort in Biological valve failure or prosthetic valve endocarditis following TAVR (n=10). Transcatheter aortic valve replacement (TAVR) explantation was evaluated on 30-day mortality. TAVR explantation in a Japanese high-volume center was associated with a 20% 30-day mortality rate and a 40% 3-year survival rate, with 90% of cases requiring concomitant procedures.
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