Annals of cardiothoracic surgery最新文献

{"title":"The current state of transcatheter aortic valve replacement explant: an updated systematic review.","authors":"Michel Pompeu Sá, Eishan Ashwat, Xander Jacquemyn, Danial Ahmad, James A Brown, Derek Serna-Gallegos, Asishana Osho, Jordan P Bloom, Ibrahim Sultan","doi":"10.21037/acs-2024-etavr-0075","DOIUrl":"https://doi.org/10.21037/acs-2024-etavr-0075","url":null,"abstract":"<p><strong>Background: </strong>Despite ever-growing adoption of transcatheter aortic valve replacement (TAVR) in younger healthier patients, a limited number of studies have described post-TAVR valve reinterventions such as surgical explantation known as \"TAVR explant\".</p><p><strong>Methods: </strong>We performed a systematic review to characterize the current state of TAVR explant in patients with a failing transcatheter heart valve (THV) using data published by April 30, 2024 in compliance with the PRISMA and MOOSE reporting guidelines. The protocol was registered in PROSPERO (CRD42024529188).</p><p><strong>Results: </strong>Twenty-eight studies met the eligibility criteria. Almost all studies were non-randomized, observational, and retrospective. The incidence of TAVR explant ranged from 0.2% to 2.8% in patients with a mean age of 67.3-79.0 years, and women representing 25.0-47.1% of cases. The mean time between TAVR implant and explant was 17.0-674.9 days, with most studies reporting a mean time <365 days. Whereas the Society of Thoracic Surgeons-Predicted Risk of Mortality (STS-PROM) score at the time of the TAVR implant ranged between 2.6% and 7.7% (with only one study with score >5%), the STS-PROM score at the time of the TAVR explant ranged between 3.9% and 9.9% (with 17 studies with score >5%). Isolated surgical aortic valve replacement (SAVR) happened in 16.2-100% of cases, aortic root replacement was required in 2.6-41.2%, ascending aortic replacement was performed in 3.2-33.3% of cases. Mitral valve repair/replacement was necessary in 11.8-43.5% and tricuspid valve/repair replacement was done in 2.8-25.0%. Stroke rates were between 0.0% and 20.0% with most studies with rates above 4.0%. The 30-day death rate ranged from 4.8% to 50.0% with most studies with mortality rates higher than 10%. Observed-to-expected mortality ratio was higher than 1.0 in almost all the studies that reported this variable.</p><p><strong>Conclusions: </strong>TAVR explant remains a rare event, but its clinical impact is non-negligible. Lifetime management strategies should be adopted in younger lower-risk patients when choosing THVs for the index TAVR.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 2","pages":"85-97"},"PeriodicalIF":3.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter aortic valve replacement explant for self-expandable valves.","authors":"Fatima Qamar, Michael J Reardon, Marvin Atkins","doi":"10.21037/acs-2024-etavr-0148","DOIUrl":"https://doi.org/10.21037/acs-2024-etavr-0148","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 2","pages":"170-172"},"PeriodicalIF":3.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of minimally invasive approaches for transcatheter aortic valve replacement explant: when and how?","authors":"Bryon A Tompkins, Dorsa Majdpour, Tom C Nguyen","doi":"10.21037/acs-2024-etavr-0107","DOIUrl":"https://doi.org/10.21037/acs-2024-etavr-0107","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 2","pages":"167-169"},"PeriodicalIF":3.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The future direction of post-transcatheter aortic valve replacement re-interventions: insights from the Society of Thoracic Surgeons National Database.","authors":"Michael E Bowdish, Vinay Badhwar","doi":"10.21037/acs-2024-etavr-0136","DOIUrl":"https://doi.org/10.21037/acs-2024-etavr-0136","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 2","pages":"151-153"},"PeriodicalIF":3.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter aortic valve replacement explant various techniques.","authors":"Alexander A Brescia, Puja Kachroo, Tsuyoshi Kaneko","doi":"10.21037/acs-2024-etavr-12","DOIUrl":"https://doi.org/10.21037/acs-2024-etavr-12","url":null,"abstract":"<p><p>Surgical aortic valve replacement (SAVR) has long been the gold standard for treating significant aortic valve dysfunction. Since the introduction of transcatheter aortic valve replacement (TAVR) in 2011, the number of TAVRs has grown rapidly, surpassing SAVR volumes by 2018 and now accounting for approximately 80% of all aortic valve replacements (AVRs) performed in the United States. In conjunction with the rapid expansion of TAVR, the number of TAVR valves requiring surgical explantation (TAVR-explant) has also increased due to procedure-related failure, endocarditis, structural valve degeneration with unfavorable anatomy for redo-TAVR, paravalvular leak, delayed migration, or prosthesis-patient mismatch. Often involving concomitant cardiac surgery, TAVR-explant has been associated with higher operative mortality than redo-SAVR. TAVR-explant is currently the fastest-growing cardiac procedure in the United States and is expected to continue growing, especially as TAVR is increasingly used for lower surgical risk and younger patients. Accordingly, describing and disseminating a standardized set of technical principles for performing TAVR-explant is essential for preparing all cardiac surgeons to appropriately treat these patients. TAVR-explant requires a comprehensive preoperative clinical and cross-sectional imaging assessment to plan an effective operation, including cannulation, aortotomy, explantation, and implantation strategies. Particular considerations for self-expanding and balloon-expandable TAVR valves are important for guiding the operation and optimizing outcomes. Special considerations, such as the need for concomitant aortic, coronary, or mitral valve surgery and the presence of snorkel coronary artery stents adjacent to the TAVR valve, must be considered and addressed at the time of TAVR-explant surgery. Currently, TAVR-explant confers a high operative mortality and is performed at very low volumes per surgeon. As this operation becomes increasingly common, it will become essential for all cardiac surgeons to understand and implement the operation's various techniques to optimize patient outcomes.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 2","pages":"157-164"},"PeriodicalIF":3.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management is associated with improved survival for endocarditis after transcatheter aortic valve replacement.","authors":"Shinichi Fukuhara, Taichi Suzuki, G Michael Deeb, Gorav Ailawadi, Himanshu J Patel, Bo Yang, Sami El-Dalati","doi":"10.21037/acs-2024-etavr-0103","DOIUrl":"https://doi.org/10.21037/acs-2024-etavr-0103","url":null,"abstract":"<p><strong>Background: </strong>Prosthetic valve endocarditis is a rare yet devastating complication following transcatheter aortic valve replacement (TAVR). This study aims to investigate the outcomes of surgical versus medical management of post-TAVR endocarditis.</p><p><strong>Methods: </strong>Between 2011 and 2024, 67 patients with post-TAVR endocarditis were identified, comprising 24 (35.8%) patients managed surgically and 43 (64.2%) managed medically. All cases were reviewed by our multidisciplinary endocarditis team to determine the optimal treatment strategy.</p><p><strong>Results: </strong>The overall incidence of post-TAVR endocarditis was 1.4%. The number of endocarditis cases increased over time from 1-2 in 2015-2018 to 18 in 2023. The most frequent source of endocarditis was unknown (32.8%), and the predominant causative organism was enterococcus species (25.4%). Notably, among the 43 medically managed patients, 19 (44.2%) exhibited surgical indications, predominantly due to large vegetations with or without embolic complications (n=11; 57.9%). The medical management group had a higher proportion of females and more frequent use of self-expandable valves compared to the surgical group. The time interval between TAVR and endocarditis diagnosis was similar across both groups. In the surgically managed cohort, isolated aortic valve replacement was uncommon, with most patients undergoing complex TAVR explantations coupled with concomitant procedures, most frequently aortic root repair (n=11; 45.8%). The 30-day and 1-year mortality rates for the three groups (surgical, medical without surgical indications, and medical with surgical indications) were 0%, 4.2%, and 31.6% (P=0.002), and 4.2%, 20.8%, and 73.7% (P<0.001), respectively.</p><p><strong>Conclusions: </strong>Surgical management was associated with significantly improved survival compared to medical management for post-TAVR endocarditis. The poor clinical outcomes in the medically managed group were primarily due to patients who did not undergo surgery despite having surgical indications. Prudent clinical judgment and timely surgical intervention when indicated are critical to enhancing the overall clinical outcomes of this challenging condition.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 2","pages":"141-150"},"PeriodicalIF":3.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The future direction of post-transcatheter aortic valve replacement reinterventions: insights from the Transcatheter Valve Therapy Registry.","authors":"Edward Percy, Joseph E Bavaria","doi":"10.21037/acs-2025-etavr-0019","DOIUrl":"https://doi.org/10.21037/acs-2025-etavr-0019","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 2","pages":"154-156"},"PeriodicalIF":3.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to avoid transcatheter aortic valve replacement explant as the second valve procedure: image assessment for the index transcatheter aortic valve replacement.","authors":"Kendra J Grubb, Hiroki A Ueyama, Stephanie K Tom, R Michael Reul, Alexander P Nissen, Andy Tully, Anton Camaj, John Lisko, Joe Xie, Elizabeth L Norton, Kanika Kalra, Patrick T Gleason","doi":"10.21037/acs-2024-etavr-0190","DOIUrl":"https://doi.org/10.21037/acs-2024-etavr-0190","url":null,"abstract":"<p><p>The management of severe aortic stenosis (AS) has evolved significantly, with a shift toward shared decision-making regarding the choice of transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). This shift necessitates careful consideration of long-term valve durability, as both TAVR and SAVR with bioprosthetic valves offer limited durability, potentially requiring reoperation later in life. While mechanical valves and the Ross procedure offer lifelong durability, patient preferences, including avoidance of anticoagulation, often dominate the discussion. This manuscript reviews the complex decision-making process in selecting the most appropriate valve for the first intervention, focusing on balancing the immediate benefits of a less invasive procedure with the long-term risks and the potential need for a second valve intervention. In the TAVR era, younger patients elect the least invasive treatment option with the shortest recovery. Age, anticoagulation tolerance, comorbidities, and aortic root anatomy influence valve choice, with particular attention to prosthesis-patient mismatch (PPM). Here, we emphasize that careful preoperative planning is essential to minimize PPM and optimize hemodynamics for the first valve, considering the possibility of future valve interventions. Furthermore, advanced imaging and simulation tools, such as computed tomography (CT) and artificial intelligence-based platforms, are now being utilized to predict the feasibility of redo interventions and guide the selection of the initial valve. The increasing prevalence of redo-TAVR and TAVR explantation underscores the importance of planning for a second valve at the time of the initial intervention. Simulation techniques can predict the anatomical feasibility of redo-TAVR, providing a safer framework for managing patients requiring subsequent valve replacements. Ultimately, heart teams must equip themselves with the tools and expertise necessary to ensure the durability of the first valve and readiness for future interventions, thereby improving patient outcomes over their lifetimes.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 2","pages":"112-121"},"PeriodicalIF":3.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of TAVR explant stratified by original risk profile: insights from 110 TAVR explants.","authors":"Shinichi Fukuhara, Taichi Suzuki, G Michael Deeb, Gorav Ailawadi, Himanshu J Patel, Bo Yang","doi":"10.21037/acs-2024-etavr-0104","DOIUrl":"https://doi.org/10.21037/acs-2024-etavr-0104","url":null,"abstract":"<p><strong>Background: </strong>Reoperations after transcatheter aortic valve replacement (TAVR) are increasingly reported with consistently poor outcomes. This study aimed to analyze clinical outcomes of TAVR explantation stratified by the original risk profile at the time of TAVR.</p><p><strong>Methods: </strong>We reviewed our single institutional series of 110 consecutive patients who underwent TAVR explant between 2013 and 2024. This cohort was stratified into low-risk (n=35), intermediate-risk (n=35), and high/extreme-risk (n=40) categories based on the original risk profile.</p><p><strong>Results: </strong>Low-risk patients began to appear in 2018. By 2021, the number of low/intermediate-risk patients surpassed that of the high/extreme-risk group. Balloon-expandable valves were predominantly used in the low-risk group, whereas chronic kidney disease was more prevalent in the other groups. The majority of patients in each group had either structural valve deterioration (SVD) and/or non-SVD as the primary failure mechanism, with endocarditis accounting for 20% or less. Cardiopulmonary bypass/aortic cross-clamp times were longest in the high-/extreme-risk group. Overall, 75 (68.2%) patients underwent a concomitant procedure during TAVR explant, most commonly an aortic (n=39; 52.0%) and a mitral procedure (n=29; 38.7%). The high/extreme-risk group had the highest rates of concomitant procedures. Operative mortality improved significantly over time, dropping from 27.3% in Era 1 (2013-2017) to 5.6% in Era 3 (2022-2024) (P=0.049). The operative and one-year mortality rates were 8.6%, 8.6%, and 7.5% (P=0.98), and 17.1%, 8.6%, and 17.5% (P=0.48) in the low-, intermediate-, and high-/extreme-risk group, respectively. Conversely, the observed-to-expected mortality ratio (O/E ratio) was highest in the low-risk group (2.8 <i>vs.</i> 1.0 <i>vs.</i> 0.8; P<0.001).</p><p><strong>Conclusions: </strong>Low-risk patients are emerging as the predominant group requiring TAVR explant. Despite the procedural simplicity and lower-risk profile, the operative mortality was comparable to higher-risk groups, and the O/E ratio was significantly higher in the low-risk group. Thoughtful reconsideration of the TAVR-first approach may be warranted for this population.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 2","pages":"122-130"},"PeriodicalIF":3.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A glimpse into the future of valve-in-valve to treat early bioprosthesis structural degeneration-are we really doing right?","authors":"Laura Besola, Federico Giorgi, Michele Celiento, Danilo Ruggiero, Giacomo Ravenni, Andrea Colli","doi":"10.21037/acs-2025-etavr-14","DOIUrl":"https://doi.org/10.21037/acs-2025-etavr-14","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 2","pages":"179-181"},"PeriodicalIF":3.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}