Surgical Explantation of Transcatheter Aortic Bioprostheses: Balloon vs Self-Expandable Devices

BACKGROUND Despite the rapid adoption of transcatheter aortic replacement (TAVR), surgical TAVR valve explantation (TAVR-explant) and the clinical impact of explanted TAVR device type are not well described. METHODS TAVR-explant from 2016 to 2019 was queried using the Society of Thoracic Surgeons (STS) National Database. A total of 483 patients with documented explanted valve type, consisting of 330 (68%) patients with balloon expandable and 153 (32%) patients with self-expandable devices, were identified. The primary outcome was 30-day mortality. The secondary outcome was the need for any simultaneous procedures with TAVR-explant. RESULTS The mean age was 72.8 years, 38% of the patients were female, and 51% demonstrated New York Heart Association functional class III to IV symptoms. During TAVR-explant, 63% of patients required other simultaneous procedures, including aortic repair (27%), mitral procedures (22%), coronary artery bypass grafting (15%), and tricuspid procedures (7%). Patients with a self-expandable device underwent more frequent ascending aortic replacement (22% vs 9%; P < .001) than those with a balloon-expandable device, whereas the aortic root replacement rate was similar (19% vs 24%; P [ .22). The overall 30-day mortality was 18% without differences in the mortality or other major complications between the groups. Of the 157 patients with isolated surgical aortic valve replacement and available STS predicted risk of mortality score, the observed-to-expected (O/E) mortality ratio was 2.2. CONCLUSIONS The TAVR-explant outcomes were comparable between patients with balloon-expandable devices and patients with self-expandable devices, whereas ascending aortic replacement was observed more frequently in patients with self-expandable devices. Younger patients undergoing TAVR should be informed of the future TAVR-explant risk that may accompany a higher O/E ratio and frequent morbid concurrent procedures. (Ann Thorac Surg 2022;113:138-45) (c) 2022 by The Society of Thoracic Surgeons

Automated summary

This study examined 483 patients who underwent TAVR-explant surgery from 2016 to 2019, revealing differences in the need for additional simultaneous procedures during surgery for patients using different types of TAVR devices, but no significant differences in 30-day mortality rate or other major complications were observed between the groups.