Vitanova Keti, Zaid Syed, Tang Gilbert H L, Kaneko Tsuyoshi, Bapat Vinayak N, Modine Thomas, Denti Paolo
German Heart Center Munich, Munich, Germany.
Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex.
J Thorac Cardiovasc Surg. 2023 Nov;166(5):1418-1430.e4. doi: 10.1016/j.jtcvs.2021.12.060. Epub 2022 Mar 26.
We sought to determine outcomes of aortic valve replacement (AVR) versus root replacement after transcatheter AVR (TAVR) explantation because they remain unknown.
From November 2009 to September 2020, data from the EXPLANT-TAVR International Registry of patients who underwent TAVR explant were retrospectively reviewed, divided by AVR versus root replacement. After excluding explants performed during the same admission as the initial TAVR and concomitant procedures involving the other valves, 168 AVR cases were compared with 28 root replacements, and outcomes were reported at 30 days and 1 year.
Among 196 patients (mean age, 73.5 ± 9.9 years) who had primary aortic valve intervention at TAVR explant, the median time from TAVR to surgical explant was 11.2 months (interquartile range, 4.4-32.9 months). Indications for explant were similar between the 2 groups. Compared with AVR, patients requiring root replacement had fewer comorbidities but more unfavorable anatomy for redo TAVR (52.6% vs 26.4%; P = .032), fewer urgent/emergency cases (32.1% vs 58.3%; P = .013), longer median interval from index TAVR to TAVR explant (17.6 vs 9.9 months; P = .047), and more concomitant ascending aortic replacement (58.8% vs 14.0%; P < .001). Median follow-up was 6.9 months (interquartile range, 1.4-21.6 months) after TAVR explant and 97.4% complete. Overall survival at follow-up was 81.2% with no differences between groups (log rank P = .54). In-hospital, 30-day, and 1-year mortality rates and stroke rates were not different between the 2 groups.
In the EXPLANT-TAVR Registry, AVR and root replacement groups had different clinical characteristics, but no differences in short-term mortality and morbidities. Further investigations are necessary to identify patients at risk of root replacement in TAVR explant.
我们试图确定经导管主动脉瓣置换术（TAVR）植入物取出术后行主动脉瓣置换（AVR）与根部置换的结果，因为这些结果尚不清楚。
回顾性分析2009年11月至2020年9月EXPLANT-TAVR国际登记处中接受TAVR植入物取出术患者的数据，根据AVR与根部置换进行分组。在排除与初次TAVR在同一住院期间进行的植入物取出术以及涉及其他瓣膜的同期手术之后，将168例AVR病例与28例根部置换病例进行比较，并报告30天和1年时的结果。
在196例（平均年龄73.5±9.9岁）在TAVR植入物取出时接受初次主动脉瓣干预的患者中，从TAVR到手术取出植入物的中位时间为11.2个月（四分位间距为4.4 - 32.9个月）。两组间取出植入物的指征相似。与AVR相比，需要进行根部置换的患者合并症较少，但再次行TAVR的解剖结构更不理想（52.6%对26.4%；P = 0.032），紧急/急诊病例较少（32.1%对58.3%；P = 0.013），从初次TAVR到TAVR植入物取出的中位间隔时间更长（17.6对9.9个月；P = 0.047），同期升主动脉置换更多（58.8%对14.0%；P < 0.001）。TAVR植入物取出术后的中位随访时间为6.9个月（四分位间距为1.4 - 2l.6个月），随访完成率为97.4%。随访时的总生存率为81.2%，两组间无差异（对数秩检验P = 0.54）。两组的住院死亡率、30天死亡率、1年死亡率和卒中发生率均无差异。
在EXPLANT-TAVR登记处中，AVR组和根部置换组具有不同的临床特征，但短期死亡率和发病率无差异。有必要进一步研究以确定TAVR植入物取出时存在根部置换风险的患者。
