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Surgical explantation of transcatheter aortic bioprostheses: Results and clinical implications
| Content Provider | Scilit |
|---|---|
| Author | Fukuhara, Shinichi Brescia, Alexander A. Shiomi, Suzuna Rosati, Carlo M. Yang, Bo Kim, Karen M. Deeb, G. Michael |
| Copyright Year | 2020 |
| Description | Journal: Journal of Thoracic and Cardiovascular Surgery Despite the rapid adoption of transcatheter aortic valve replacement (TAVR) and worldwide interest in its implantation, TAVR valve explantation has not been well-described. We retrospectively reviewed 1,442 consecutive patients who underwent a TAVR between 2011-2019, in which TAVR explantation was performed in 15 (1.0%) patients. In addition, two patients from outside institutions also underwent TAVR explantation at our institution. We reviewed the clinical details of these 17 patients. The frequency of TAVR explant increased over time from 0-1 in 2011-2015 to 6 in 2019. The mean age was 73.0±9.3. The majority of patients (88.2%) were in NYHA class IV heart failure. The Society of Thoracic Surgeons Predicted Risk of Mortality score was significantly higher at the time of explantation than the time of the original TAVR (3.5 vs. 9.9%, p<0.001). The indication for explantation included structural valve degeneration (23.5%), severe paravalvular leak (41.2%), TAVR procedural complications (23.5%), endocarditis (5.9%) and bridge-to-definitive surgery (5.9%). Neoendothelialization of the TAVR valve into the aortic wall requiring intense aortic endarterectomy was noted in all 5 of the TAVR valves older than 1 year, in which two (40%) required unplanned aortic root repair. There were two (11.8%) in-hospital mortalities. Surgical TAVR valve explant is increasing and may become common in the near future. The clinical impact of explanting chronically-implanted valves with the potential need for aortic repair is not negligible. These data should be used to more appropriately select TAVR candidates as TAVR practices expand into younger and lower risk patients. |
| Related Links | http://www.jtcvs.org/article/S0022522320300611/pdf |
| ISSN | 00225223 |
| e-ISSN | 1097685X |
| DOI | 10.1016/j.jtcvs.2019.11.139 |
| Journal | Journal of Thoracic and Cardiovascular Surgery |
| Issue Number | 2 |
| Volume Number | 162 |
| Language | English |
| Publisher | Elsevier BV |
| Publisher Date | 2020-01-12 |
| Access Restriction | Open |
| Subject Keyword | Journal: Journal of Thoracic and Cardiovascular Surgery Cardiology and Cardiovascular Diseases Transcatheter Aortic Valve Replacement Surgical Aortic Valve Replacement The Society of Thoracic Surgeons Predicted Risk of Mortality Coronary Artery Bypass Grafting Interquartile Range Chronic Obstructive Pulmonary Disease Paravalvular Leak Structural Valve Degeneration Transcatheter Aortic Valve Replacement in Transcatheter Aortic Valve New York Heart Association |
| Content Type | Text |
| Resource Type | Article |
| Subject | Pulmonary and Respiratory Medicine Surgery Cardiology and Cardiovascular Medicine |
