Early Predictors of Surgical Explantation of Transcatheter Aortic Valve Replacement: A Multi-Center International Database Analysis

<b>Background</b>: Indications for TAVR explant have been established, although limited data exist regarding pre-TAVR baseline characteristics that predict eventual explantation. <b>Methods</b>: The TriNetX network, a database comprising medical records from over 105 institutions, was used. Two cohorts were created: those who underwent TAVR without explant and those requiring subsequent TAVR explant and SAVR. Predictors of explantation were analyzed by multivariate models. <b>Results</b>: Among the 63,377 patients undergoing TAVR, 273 (0.4%) required explantation. Patients in the explant group were younger (69.1 ± 11.3 vs. 78.1 ± 8.8 years; <i>p</i> < 0.001), more likely to have a thoracic aortic aneurysm (TAA) (10.6% vs. 4.7%; <i>p</i> < 0.001) and had higher LDL levels (88.2 ± 41.3 vs. 80.7 ± 34.6 mg/dL; <i>p</i> = 0.011). They also had increased post-TAVR rates of acute kidney injury (9.2% vs. 5.2%; <i>p</i> = 0.004) and paravalvular leak (5.9% vs. 0.9%; <i>p</i> < 0.001). Age at TAVR (HR 1.04; CI 1.03-1.06), baseline TAA (HR 1.69; CI 1.09-2.63), history of infective endocarditis (HR 1.92; CI 1.10-3.35), and higher LDL (HR 1.02; 95% CI 1.00-1.03) were independent predictors for explantation. <b>Conclusions</b>: Younger age at TAVR, TAA, history of endocarditis, and elevated baseline LDL were notable predictors of explantation. These findings highlight the necessity of pre-procedural assessment and follow-up in high-risk patients to optimize TAVR durability.