Transcatheter heart valve explant with infective endocarditis-associated prosthesis failure and outcomes: the EXPLANT-TAVR international registry
Author:
Marin-Cuartas Mateo1ORCID, Tang Gilbert H L2, Kiefer Philipp1, Fukuhara Shinichi3, Lange Rudiger4, Harrington Katherine B5, Saha Shekhar67ORCID, Hagl Christian67, Kleiman Neal S8, Goel Sachin S9, Kempfert Joerg9, Werner Paul10ORCID, Petrossian George A11, Geirsson Arnar12, Desai Nimesh D13, Chu Michael W A14, Bhadra Oliver D15, Shults Christian16, Garatti Andrea17ORCID, Vincent Flavien18, Grubb Kendra J19, Goldberg Joshua B20, Mack Michael J5, Modine Thomas21ORCID, Denti Paolo22, Kaneko Tsuyoshi23, Bapat Vinayak N24, Reardon Michael J8ORCID, Borger Michael A1, Zaid Syed25, , Bruschi Giuseppe, Squiers John J, Szerlip Molly I, DiMaio J Michael, Hirji Sameer, Shah Pinak B, Leroux Lionel, Van Belle Eric, Koussa Mohammad, Nazif Tamim M, George Isaac, Van Mieghem Nicholas M, Hokken Thijmen W, Unbehaun Axel, Vitanova Keti, Atkins Marvin D, Doty John R, Whisenant Brian K, Di Eusanio Marco, Capestro Filippo, Ramlawi Basel, Holzhey David, Noack Thilo, Pirelli Luigi, Brinster Derek R, Algadheeb Muhanad, Bagur Rodrigo, Di Virgilio Antonio, Salinger Michael H, Andreas Martin, Satler Lowell F, Waksman Ron, Ali Walid Ben, Ibrahim Reda, Demers Philippe, Rovin Joshua, Voisine Pierre, Mohammadi Siamak, Rodés-Cabau Josep, Gelpi Guido, Belluschi Igor, Maisano Francesco, Robinson Newell B, Wang Lin, Ouzounian Maral, Conradi Lenard, Estevez-Loureiro Rodrigo, Pinon Miguel A, Wyler von Ballmoos Moritz, Nguyen Tom C, Deeb G Michael, Ruel Marc, Al-Atassi Talal, D’Onofrio Augusto, Tessari Chiara, Bavaria Joseph E, Colli Andrea, Pizano Alejandro, Goel Kashish, Shah Ashish S, Ahmad Hasan A, Forrest John K, Taramasso Maurizio, Gennari Marco
Affiliation:
1. University Department of Cardiac Surgery, Leipzig Heart Center , Leipzig , Germany 2. Department of Cardiovascular Surgery, Mount Sinai Medical Center , 1190 Fifth Avenue, GP2W, Box 1028, New York, NY 10029 , USA 3. University of Michigan , Ann Arbor, MI , USA 4. German Heart Center Munich , Munich , Germany 5. Baylor, Scott & White The Heart Hospital , Plano, TX , USA 6. Department of Cardiac Surgery, Ludwig Maximillian University Munich , Munich , Germany 7. German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance , Munich , Germany 8. Houston Methodist DeBakey Heart and Vascular Center , Houston, TX , USA 9. German Heart Center Berlin at Charité , Berlin , Germany 10. Medical University of Vienna , Vienna , Austria 11. St. Francis Hospital , Roslyn, NY , USA 12. Columbia University Irving Medical Center , New York, NY , USA 13. University of Pennsylvania , Philadelphia, PA , USA 14. London Health Sciences Center, Western University , London, ON , Canada 15. Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg , Hamburg , Germany 16. MedStar Washington Hospital Center , Washington, DC , USA 17. IRCCS Policlinico San Donato , Milan , Italy 18. CHU Lille, University of Lille , Lille , France 19. Emory University , Atlanta, GA , USA 20. Westchester Medical Center , Valhalla, NY , USA 21. CHU Bordeaux , Bordeaux , France 22. San Raffaele University Hospital , Milan , Italy 23. Washington University School of Medicine , St. Louis, MO , USA 24. Abbott Northwestern Hospital , Minneapolis, MN , USA 25. Baylor College of Medicine , Houston, TX , USA
Abstract
Abstract
Background and Aims
Surgical explantation of transcatheter heart valves (THVs) is rapidly increasing, but there are limited data on patients with THV-associated infective endocarditis (IE). This study aims to assess the outcomes of patients undergoing THV explant for IE.
Methods
All patients who underwent THV explant between 2011 and 2022 from 44 sites in the EXPLANT-TAVR registry were identified. Patients with IE as the reason for THV explant were compared to those with other mechanisms of bioprosthetic valve dysfunction (BVD).
Results
A total of 372 patients from the EXPLANT-TAVR registry were included. Among them, 184 (49.5%) patients underwent THV explant due to IE and 188 (50.5%) patients due to BVD. At the index transcatheter aortic valve replacement, patients undergoing THV explant for IE were older (74.3 ± 8.6 vs. 71 ± 10.6 years) and had a lower Society of Thoracic Surgeons risk score [2.6% (1.8–5.0) vs. 3.3% (2.1–5.6), P = .029] compared to patients with BVD. Compared to BVD, IE patients had longer intensive care unit and hospital stays (P < .05) and higher stroke rates at 30 days (8.6% vs. 2.9%, P = .032) and 1 year (16.2% vs. 5.2%, P = .010). Adjusted in-hospital, 30-day, and 1-year mortality was 12.1%, 16.1%, and 33.8%, respectively, for the entire cohort, with no significant differences between groups. Although mortality was numerically higher in IE patients 3 years postsurgery (29.6% for BVD vs. 43.9% for IE), Kaplan–Meier analysis showed no significant differences between groups (P = .16).
Conclusions
In the EXPLANT-TAVR registry, patients undergoing THV explant for IE had higher 30-day and 1-year stroke rates and longer intensive care unit and hospital stays. Moreover, patients undergoing THV explant for IE had a higher 3-year mortality rate, which did not reach statistical significance given the relatively small sample size of this unique cohort and the reduced number of events.
Publisher
Oxford University Press (OUP)
Cited by
2 articles.
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