Bhavandhar Penta, Gilbert H L Tang, Mohamed Abdel-Wahab, Rik Adrichem, Hasan Ahmad, Martin Andreas, Anita W Asgar, Igor Belluschi, Walid Ben-Ali, Oliver Bhadra, Anson Cheung, Andrea Colli, Lenard Conradi, Silvia Corona, Ole De Backer, Paolo Denti, Nimesh D Desai, Marco Di Eusanio, J Michael DiMaio, John K Forrest, Shinichi Fukuhara, Arnar Geirsson, Sachin S Goel, Joshua B Goldberg, Christian Hagl, Howard C Herrmann, Thijmen W Hokken, Jorg Kempfert, Philipp Kiefer, Neal S Kleiman, Chad A Kliger, Markus Mach, Mateo Marin-Cuartas, David Meier, Thomas Modine, George Petrossian, Luigi Pirelli, Basel Ramlawi, Newell Robinson, Joshua D Rovin, Hendrik Ruge, Shekhar Saha, Christian C Schults, Emily Shih, Molly Szerlip, Maurizio Taramasso, Axel Unbehaun, Nicolas Van Mieghem, Keti Vitanova, Ron Waksman, Lin Wang, John G Webb, Moritz Wyler von Ballmoos, Michael J Reardon, Tamim N Nazif, Martin B Leon, Michael J Mack, Tsuyoshi Kaneko, Vinayak N Bapat, Syed Zaid
{"title":"TAVR失败机制对再干预后结果的影响：来自explortorredo -TAVR注册表。","authors":"Bhavandhar Penta, Gilbert H L Tang, Mohamed Abdel-Wahab, Rik Adrichem, Hasan Ahmad, Martin Andreas, Anita W Asgar, Igor Belluschi, Walid Ben-Ali, Oliver Bhadra, Anson Cheung, Andrea Colli, Lenard Conradi, Silvia Corona, Ole De Backer, Paolo Denti, Nimesh D Desai, Marco Di Eusanio, J Michael DiMaio, John K Forrest, Shinichi Fukuhara, Arnar Geirsson, Sachin S Goel, Joshua B Goldberg, Christian Hagl, Howard C Herrmann, Thijmen W Hokken, Jorg Kempfert, Philipp Kiefer, Neal S Kleiman, Chad A Kliger, Markus Mach, Mateo Marin-Cuartas, David Meier, Thomas Modine, George Petrossian, Luigi Pirelli, Basel Ramlawi, Newell Robinson, Joshua D Rovin, Hendrik Ruge, Shekhar Saha, Christian C Schults, Emily Shih, Molly Szerlip, Maurizio Taramasso, Axel Unbehaun, Nicolas Van Mieghem, Keti Vitanova, Ron Waksman, Lin Wang, John G Webb, Moritz Wyler von Ballmoos, Michael J Reardon, Tamim N Nazif, Martin B Leon, Michael J Mack, Tsuyoshi Kaneko, Vinayak N Bapat, Syed Zaid","doi":"10.1161/CIRCINTERVENTIONS.125.016068","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>As transcatheter aortic valve replacement (TAVR) expands to patients with longer life expectancy, the impact of failure mechanisms on outcomes of TAVR-explant and redo-TAVR remains uncertain. We sought to evaluate outcomes of TAVR reintervention based on the failure mechanism of the index transcatheter aortic valve.</p><p><strong>Methods: </strong>From 2009 to 2022, 553 patients from 29 centers in the EXPLANTORREDO-TAVR registry underwent TAVR-explant or redo-TAVR for transcatheter aortic valve failure. Patients with endocarditis were excluded. Patients with structural valve deterioration (SVD, N=224 [64.9%]) were compared with those with nonstructural valve dysfunction (NSVD, N=121 [35.1%]), comprising paravalvular leak (86.0%) and prosthesis-patient mismatch (14.0%). Outcomes were assessed at 30 days and 1 year.</p><p><strong>Results: </strong>Mean age was 75.6±9.3 years, with 42% women. There were no differences in reintervention type between groups (redo-TAVR in 58.0% SVD versus 49.6% NSVD; TAVR-explant: 42.0% versus 50.4%; <i>P</i>=0.14). Compared with NSVD, SVD was the predominant mode of failure in balloon-expandable valves (50.7% versus 24.8%; <i>P</i><0.001), had a longer time to reintervention (50.7 versus 5.5 months; <i>P</i><0.001), and favored non-balloon-expandable valves at redo-TAVR (56.9% versus 33.3%; <i>P</i>=0.003). Mortality at 30 days and 1 year did not differ significantly between SVD and NSVD for either redo-TAVR (30 days: 3.2% versus 1.7%, <i>P</i>=1.00; 1 year: 18.0% versus 12.0%; <i>P</i>=0.47) or TAVR-explant (30 days: 16.3% versus 12.1%, <i>P</i>=0.63; 1 year: 40.0% versus 29.5%; <i>P</i>=0.39). There were also no differences in risk-adjusted 3-year cumulative mortality between groups (redo-TAVR: HR, 1.30 [95% CI, 0.68-2.46], <i>P</i>=0.43 [ref=NSVD]; TAVR-explant: HR, 1.24 [95% CI, 0.64-2.41]; <i>P</i>=0.53).</p><p><strong>Conclusions: </strong>SVD and NSVD failures had distinct valve types and reintervention timing, with SVD having a longer time to TAVR reintervention, but the failure mechanism did not impact reintervention type or clinical outcomes.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e016068"},"PeriodicalIF":7.4000,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of TAVR Failure Mechanism on Outcomes After Reintervention: From the EXPLANTORREDO-TAVR Registry.\",\"authors\":\"Bhavandhar Penta, Gilbert H L Tang, Mohamed Abdel-Wahab, Rik Adrichem, Hasan Ahmad, Martin Andreas, Anita W Asgar, Igor Belluschi, Walid Ben-Ali, Oliver Bhadra, Anson Cheung, Andrea Colli, Lenard Conradi, Silvia Corona, Ole De Backer, Paolo Denti, Nimesh D Desai, Marco Di Eusanio, J Michael DiMaio, John K Forrest, Shinichi Fukuhara, Arnar Geirsson, Sachin S Goel, Joshua B Goldberg, Christian Hagl, Howard C Herrmann, Thijmen W Hokken, Jorg Kempfert, Philipp Kiefer, Neal S Kleiman, Chad A Kliger, Markus Mach, Mateo Marin-Cuartas, David Meier, Thomas Modine, George Petrossian, Luigi Pirelli, Basel Ramlawi, Newell Robinson, Joshua D Rovin, Hendrik Ruge, Shekhar Saha, Christian C Schults, Emily Shih, Molly Szerlip, Maurizio Taramasso, Axel Unbehaun, Nicolas Van Mieghem, Keti Vitanova, Ron Waksman, Lin Wang, John G Webb, Moritz Wyler von Ballmoos, Michael J Reardon, Tamim N Nazif, Martin B Leon, Michael J Mack, Tsuyoshi Kaneko, Vinayak N Bapat, Syed Zaid\",\"doi\":\"10.1161/CIRCINTERVENTIONS.125.016068\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>As transcatheter aortic valve replacement (TAVR) expands to patients with longer life expectancy, the impact of failure mechanisms on outcomes of TAVR-explant and redo-TAVR remains uncertain. We sought to evaluate outcomes of TAVR reintervention based on the failure mechanism of the index transcatheter aortic valve.</p><p><strong>Methods: </strong>From 2009 to 2022, 553 patients from 29 centers in the EXPLANTORREDO-TAVR registry underwent TAVR-explant or redo-TAVR for transcatheter aortic valve failure. Patients with endocarditis were excluded. Patients with structural valve deterioration (SVD, N=224 [64.9%]) were compared with those with nonstructural valve dysfunction (NSVD, N=121 [35.1%]), comprising paravalvular leak (86.0%) and prosthesis-patient mismatch (14.0%). Outcomes were assessed at 30 days and 1 year.</p><p><strong>Results: </strong>Mean age was 75.6±9.3 years, with 42% women. There were no differences in reintervention type between groups (redo-TAVR in 58.0% SVD versus 49.6% NSVD; TAVR-explant: 42.0% versus 50.4%; <i>P</i>=0.14). Compared with NSVD, SVD was the predominant mode of failure in balloon-expandable valves (50.7% versus 24.8%; <i>P</i><0.001), had a longer time to reintervention (50.7 versus 5.5 months; <i>P</i><0.001), and favored non-balloon-expandable valves at redo-TAVR (56.9% versus 33.3%; <i>P</i>=0.003). Mortality at 30 days and 1 year did not differ significantly between SVD and NSVD for either redo-TAVR (30 days: 3.2% versus 1.7%, <i>P</i>=1.00; 1 year: 18.0% versus 12.0%; <i>P</i>=0.47) or TAVR-explant (30 days: 16.3% versus 12.1%, <i>P</i>=0.63; 1 year: 40.0% versus 29.5%; <i>P</i>=0.39). There were also no differences in risk-adjusted 3-year cumulative mortality between groups (redo-TAVR: HR, 1.30 [95% CI, 0.68-2.46], <i>P</i>=0.43 [ref=NSVD]; TAVR-explant: HR, 1.24 [95% CI, 0.64-2.41]; <i>P</i>=0.53).</p><p><strong>Conclusions: </strong>SVD and NSVD failures had distinct valve types and reintervention timing, with SVD having a longer time to TAVR reintervention, but the failure mechanism did not impact reintervention type or clinical outcomes.</p>\",\"PeriodicalId\":10330,\"journal\":{\"name\":\"Circulation: Cardiovascular Interventions\",\"volume\":\" \",\"pages\":\"e016068\"},\"PeriodicalIF\":7.4000,\"publicationDate\":\"2026-04-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Circulation: Cardiovascular Interventions\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/CIRCINTERVENTIONS.125.016068\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation: Cardiovascular Interventions","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.016068","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Impact of TAVR Failure Mechanism on Outcomes After Reintervention: From the EXPLANTORREDO-TAVR Registry.
Background: As transcatheter aortic valve replacement (TAVR) expands to patients with longer life expectancy, the impact of failure mechanisms on outcomes of TAVR-explant and redo-TAVR remains uncertain. We sought to evaluate outcomes of TAVR reintervention based on the failure mechanism of the index transcatheter aortic valve.
Methods: From 2009 to 2022, 553 patients from 29 centers in the EXPLANTORREDO-TAVR registry underwent TAVR-explant or redo-TAVR for transcatheter aortic valve failure. Patients with endocarditis were excluded. Patients with structural valve deterioration (SVD, N=224 [64.9%]) were compared with those with nonstructural valve dysfunction (NSVD, N=121 [35.1%]), comprising paravalvular leak (86.0%) and prosthesis-patient mismatch (14.0%). Outcomes were assessed at 30 days and 1 year.
Results: Mean age was 75.6±9.3 years, with 42% women. There were no differences in reintervention type between groups (redo-TAVR in 58.0% SVD versus 49.6% NSVD; TAVR-explant: 42.0% versus 50.4%; P=0.14). Compared with NSVD, SVD was the predominant mode of failure in balloon-expandable valves (50.7% versus 24.8%; P<0.001), had a longer time to reintervention (50.7 versus 5.5 months; P<0.001), and favored non-balloon-expandable valves at redo-TAVR (56.9% versus 33.3%; P=0.003). Mortality at 30 days and 1 year did not differ significantly between SVD and NSVD for either redo-TAVR (30 days: 3.2% versus 1.7%, P=1.00; 1 year: 18.0% versus 12.0%; P=0.47) or TAVR-explant (30 days: 16.3% versus 12.1%, P=0.63; 1 year: 40.0% versus 29.5%; P=0.39). There were also no differences in risk-adjusted 3-year cumulative mortality between groups (redo-TAVR: HR, 1.30 [95% CI, 0.68-2.46], P=0.43 [ref=NSVD]; TAVR-explant: HR, 1.24 [95% CI, 0.64-2.41]; P=0.53).
Conclusions: SVD and NSVD failures had distinct valve types and reintervention timing, with SVD having a longer time to TAVR reintervention, but the failure mechanism did not impact reintervention type or clinical outcomes.
期刊介绍：
Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.
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