Surgical Explantation After TAVR Failure

Kiefer, Philipp; Sengupta, Aditya; Conradi, Lenard; Shults, Christian; Doty, John R.; Forrest, John K.; Mieghem, N.M Van; Piñón, Miguel; Salinger, Michael H.; Nazif, Tamim; Deeb, G. Michael; Reardon, Michael J.; Bapat, Vinayak; Brinkman, William T.; DiMaio, J. Michael; George, Timothy J.; Harrington, Katherine; Mack, Michael J.; Potluri, Srinivasa; Ryan, W. H.; Schaffer, Justin M.; Smith, Robert L.; Squiers, John J.; Szerlip, Molly; Hirji, Sameer; Kaneko, Tsuyoshi; Shah, Pinak; George, Isaac; Nazif, Tamim; Rahim, Hussein; Grubb, Kendra J.; Atkins, Marvin D.; Goel, Sachin S.; Kleiman, Neal S.; Ballmoos, Moritz Wyler von; Whisenant, Brian; Satler, Lowell F.; Schults, Christian; Waksman, Ron; Fisher, Susan G.; Rovin, Joshua D.; Alexis, Sophia L.; Tang, Gilbert H.L.; Brinster, Derek R.; Kliger, Chad; Pirelli, Luigi; Rutkin, Bruce; Yu, Pey‐Jen; Petrossian, George; Robinson, N. Bryce; Wang, Lin; Deeb, Michael; Fukuhara, Shinichi; Oakley, Jessica; Bavaria, Joseph E.; Desai, Nimesh D.; Walsh, Lisa C.; Nguyen, Tom C.; Pizano, Alejandro; Ramlawi, Basel; Goel, Kashish; Shah, Ashish S.; Ahmad, Hasan; Goldberg, Joshua; Spielvogel, David; Zaid, Syed; Geirsson, Arnar; Algadheeb, Muhanad; Bagur, Rodrigo; Chu, Michael W.A.; Ali, Walid Ben; Cartier, Raymond; Demers, Philippe; Ibrahim, Réda; Mohammadi, Siamak; Rodés‐Cabau, Josep; Voisine, Pierre; Ouzounian, Maral; Abois, Alain-Philippe; Al-Atassi, Talal; Boodhwani, Munir; Dick, Alexander; Glover, Christopher; Labinaz, Marino; Lam, Buu-Khanh; Ruel, Marc; Andreas, Martin; Werner, Paul; Leroux, Lionel; Modine, Thomas; Delhaye, Cédric; Delsaux, Adeline; Denimal, Tom; Gaul, Anaïs; Juthier, Françis; Koussa, Mohammad; Pamart, Thibault; Belle, Éric Van; Vincent, Flavien; Kempfert, Joerg; Sonnabend, Svetlana; Unbehaun, Axel; Krane, Markus; Lange, Rüdiger; Münsterer, Andrea; Vitanova, Keti; Borger, Michael A.; Holzhey, David; Kiefer, Philippe; Noack, Thilo; Hagl, Christian; Saha, Shekhar; Bhadra, Oliver D.; Conradi, Len; Capestro, Filippo; Eusanio, Marco Di; Virgilio, Antonio Di; Bruschi, Giuseppe; Merlanti, Bruno; Russo, Claudio; Gelpi, Guido; Romagnoni, Claudia; Garatti, Andrea; Belluschi, Igor; Denti, Paolo; D’Onofrio, Augusto; Tessari, Chiara; Colli, Andrea; Hokken, Thijmen W.; Mieghem, Nicholas Van; Estévez‐Loureiro, Rodrigo; Pinnon, Miguel; Gennari, Marco; Maisano, Francesco; Taramasso, Maurizio

doi:10.1016/j.jcin.2021.07.015

Cited by 72 publications

(6 citation statements)

References 13 publications

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“…Finally, reviewing the international EXPLANT-TAVR registry ( n = 269), Bapat et al . noticed six surgical explants of ACURATE Neo (4.5% of all self-/mechanically expandable devices), but neither the causes for explant nor the durability of the failed prostheses was specified ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

“…In our institution, we observed a rate of SVD-related BVF of 0.84%, accounting for the two present cases over the past 5 years, which was similar to the previously mentioned studies. Finally, reviewing the international EXPLANT-TAVR registry (n = 269), Bapat et al noticed six surgical explants of ACURATE Neo (4.5% of all self-/mechanically expandable devices), but neither the causes for explant nor the durability of the failed prostheses was specified (12).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Severe structural valve deterioration after TAVR with ACURATE Neo: report of two cases

Schaeffer

Koechlin

Jeger

et al. 2023

Front. Cardiovasc. Med.

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Structural valve deterioration (SVD) of transcatheter implanted aortic valve (TAVR) prostheses leading to prosthesis dysfunction is an uncommon yet increasingly described complication. Literature is scarce on specific mechanisms and clinical presentation of SVD after TAVR, notably on self-expanding valve ACURATE Neo. We report on two cases with severe bioprosthetic failure after ACURATE Neo implantation due to leaflet disruption, and we treated them with surgical aortic valve replacement. Based on the literature, we further discuss the incidence of SVD after TAVR, the durability of ACURATE NEO, and the modes of failure of biological valve prostheses.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Severe structural valve deterioration after TAVR with ACURATE Neo: report of two cases

Schaeffer

Koechlin

Jeger

et al. 2023

Front. Cardiovasc. Med.

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show abstract

“…Careful evaluation and planning on the order and sequence of treatment options is essential (Figure 2) [39][40][41][42]. Recent data on reoperations and the valve explanation following TAVR highlight the significant surgical risks involved [43,44]. These reoperations are more common in intermediate and low-risk patients and are associated with acceptable rates of postoperative complications (when excluding emergency cases) [43].…”

Section: Lifetime Managementmentioning

confidence: 99%

“…These reoperations are more common in intermediate and low-risk patients and are associated with acceptable rates of postoperative complications (when excluding emergency cases) [43]. Notable, valve explanations have Recent data on reoperations and the valve explanation following TAVR highlight the significant surgical risks involved [43,44]. These reoperations are more common in intermediate and low-risk patients and are associated with acceptable rates of postoperative complications (when excluding emergency cases) [43].…”

Section: Lifetime Managementmentioning

confidence: 99%

The Evolving Role of Surgical Aortic Valve Replacement in the Era of Transcatheter Valvular Procedures

Juarez-Casso,

Crestanello

2023

JCM

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Surgical aortic valve replacement (SAVR) has long been the standard treatment for severe symptomatic aortic stenosis (AS). However, transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive alternative; it was initially intended for high-risk patients and has now expanded its use to patients of all risk groups. While TAVR has demonstrated promising outcomes in diverse patient populations, uncertainties persist regarding its long-term durability and potential complications, raising the issue of the ideal lifetime management strategy for patients with AS. Therefore, SAVR continues to play an important role in clinical practice, particularly in younger patients with longer life expectancies, those with complex aortic anatomy who are unsuitable for TAVR, and those requiring concomitant surgical procedures. The choice between TAVR and SAVR warrants personalized decision-making, considering patient characteristics, comorbidities, anatomical considerations, and overall life expectancy. A multidisciplinary approach involving an experienced heart team is crucial in the preoperative evaluation process. In this review, we aimed to explore the current role of surgical management in addressing aortic valve stenosis amidst the expanding utilization of less invasive transcatheter procedures.

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“…Percutaneous techniques for treating failing valvular bioprostheses are developing more and more but remain an alternative to surgery in the medium-high surgical risk group only for the aortic valve, with the TAVI technique, and for the high surgical risks associated with the more complex mitral valve. A further unknown of transcatheter valve implantation techniques is the durability of the valve bioprostheses [ 11 ] and the consequent risk in explanting a TAVR [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Looking Back to Look Forward: What to Expect in a Redo Surgery for a Bioprosthesis Replacement

Giambuzzi

Bonalumi

Ballan

et al. 2022

JCM

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Redo surgeries are becoming more common because of an increased rate of bioprosthesis implantation. We performed a retrospective study on patients who underwent redo replacement of an aortic and/or mitral bioprosthesis between 2005 and 2018 to evaluate intra-hospital mortality and morbidity. Univariate analysis was performed on the propensity score variables to determine predictors of mortality. A total of 180 patients were enrolled in the study: Group A (replacement of aortic bioprosthesis) with 136 patients (75.56%) and group B (replacement of mitral bioprosthesis ± aortic bioprosthesis) with 44 patients (24.44%). NYHA class ≥ 3 and female sex were significantly more common in group B. Cardiopulmonary-bypass time and aortic cross-clamping time in group A and group B were, respectively, 154.95 ± 74.35 and 190.25 ± 77.44 (p = 0.0005) and 115.99 ± 53.54 and 144.91 ± 52.53 (p = 0.0004). Overall mortality was 8.89%. After propensity score adjustment, Group B was confirmed to have an increased risk of death (OR 3.32 CI 95% 1.02–10.88 p < 0.0001), gastrointestinal complications (OR 7.784 CI 95% 1.005–60.282 p < 0.0002) and pulmonary complications (OR 2.381 CI 95% 1.038–5.46 p < 0.0001). At the univariate analysis, endocarditis, cardiopulmonary-bypass and aortic cross clamping time, NYHA class ≥ 3 and urgency setting were significantly associated to death. Intra-hospital outcomes were acceptable regarding mortality and complications. Patients who need redo surgery on mitral bioprosthesis have an increased risk of post-operative pulmonary and gastrointestinal complications and mortality. Therefore the choice of mitral bioprosthesis at time of first surgery should be carefully evaluated.

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Surgical Explantation After TAVR Failure

Cited by 72 publications

References 13 publications

Severe structural valve deterioration after TAVR with ACURATE Neo: report of two cases

Severe structural valve deterioration after TAVR with ACURATE Neo: report of two cases

The Evolving Role of Surgical Aortic Valve Replacement in the Era of Transcatheter Valvular Procedures

Looking Back to Look Forward: What to Expect in a Redo Surgery for a Bioprosthesis Replacement

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