September 14, 2026Circulation Cardiovascular Interventions
Impact of Initial Valve Type on Reintervention for TAVR Failure: From the EXPLANTORREDO-TAVR International Registry
Why the study?
Data are limited on how transcatheter aortic valve type affects outcomes of redo-TAVR and TAVR-explant for TAVR failure as TAVR expands to younger patients.
Does initial valve type (failed balloon-expandable vs self-expanding valves) impact reintervention strategy or survival in patients undergoing redo-TAVR or TAVR-explant for TAVR failure?
Population
Patients undergoing redo-TAVR or TAVR-explant for TAVR failure across 29 centers
Comparison
158 failed balloon-expandable valves vs 224 failed self-expanding valves
Design
International registry-based observational study
Follow-up
1 year
Key result
Reintervention for failed balloon-expandable valves compared with self-expanding valves resulted in similar mortality at 1 year (24.3% vs 21.5%; P=0.65) and 3 years.
Authors
Discussion
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Overview
Comparable reintervention mortality irrespective of initial valve type supports standardized approaches; leaves open mechanism-specific prospective trials.
Key Points
- To compare clinical outcomes, reintervention strategies, and failure modes between failed balloon-expandable valves and failed self-expanding valves undergoing redo-TAVR or surgical explantation.
- Analyzed 553 patients from 29 centers in the international EXPLANTORREDO-TAVR registry who underwent redo-TAVR or TAVR-explant between May 2009 and February 2022 during a separate admission from index TAVR.
- Excluded mechanically expanding valves and endocarditis cases, comparing 158 failed balloon-expandable valves against 224 failed self-expanding valves with follow-up at 30 days and 1 year.
- Failed balloon-expandable valves demonstrated higher rates of structural valve deterioration (73.4% vs. 46.1%, P < 0.001) and prosthesis–patient mismatch (12.3% vs. 5.5%, P = 0.022), fewer paravalvular leaks (18.2% vs. 41.1%, P < 0.001), and longer time-to-reintervention (41.8 vs. 19.7 months, P < 0.001).
- Reintervention strategy was balanced between balloon-expandable and self-expanding groups (redo-TAVR: 54.4% vs. 53.6%; TAVR-explant: 45.6% vs. 46.4%, P = 0.92), with cross-platform redo-TAVR favored in both cohorts (58.1% vs. 59.2%, P = 0.016).
- Mortality showed no significant difference at 30 days (8.7% vs. 8.0%, P = 0.85) or 1 year (24.3% vs. 21.5%, P = 0.65), with similar risk-adjusted 3-year mortality for redo-TAVR (adjusted HR 1.15 [95% CI, 0.61–2.20]) and TAVR-explant (adjusted HR 0.84 [95% CI, 0.46–1.54]).
Study Design
Type
Observational (n=553)
Multicenter
Yes
Structured PICO
Does initial valve type (failed balloon-expandable vs self-expanding valves) impact reintervention strategy or survival in patients undergoing redo-TAVR or TAVR-explant for TAVR failure?
P
Population
553 patients (mean age 75.5 years, 40.6% female) undergoing redo-TAVR or TAVR-explant for TAVR failure, followed for up to 3 years.
E
Exposure
Reintervention (redo-TAVR or TAVR-explant) for failed balloon-expandable valves (BEV) (n=158)
C
Comparator
Reintervention (redo-TAVR or TAVR-explant) for failed self-expanding valves (SEV) (n=224)
O
Outcome
Mortality at 30 days and 1 yearhard clinical
Main Result
Absolute Event Rate: 24.3% vs 21.5%
p-value: p=0.65
Initial TAVR valve type (balloon-expandable vs self-expanding) dictates the mechanism and timing of failure but does not impact survival or reintervention strategy during redo-TAVR or explant.
Cite This Study
Zaid et al. (2026) conducted an observational in TAVR failure (n=553). Failed balloon-expandable valves (BEV) vs. Failed self-expanding valves (SEV) was evaluated on Mortality at 1 year (p=0.65). Reintervention for failed balloon-expandable valves compared with self-expanding valves resulted in similar mortality at 1 year (24.3% vs 21.5%; P=0.65) and 3 years.