Impact of Initial Valve Type on Reintervention for TAVR Failure: From the EXPLANTORREDO-TAVR International Registry

BACKGROUND: As transcatheter aortic valve replacement (TAVR) expands to younger patients, there is limited data on the impact of TAV type on outcomes of TAVR-explant and redo-TAVR for TAVR failure. We sought to compare outcomes of reintervention for failed balloon-expandable valves (BEV) versus self-expanding valves (SEV). METHODS: From May 2009 to February 2022, 553 patients from 29 centers in the international EXPLANTORREDO-TAVR registry underwent redo-TAVR or TAVR-explant for TAVR failure during a separate admission from index TAVR. Mechanically expanding valves and explantation for endocarditis were excluded. 158 (41.4%) failed-BEV were compared with 224 (58.6%) failed-SEV, and outcomes were reported at 30 days and 1 year. RESULTS: Mean age at reintervention was 75.5±9.3 years, and 40.6% were female. Failed-BEV had higher proportion of structural valve deterioration (73.4% versus 46.1% in failed-SEV; P <0.001) and prosthesis–patient mismatch (12.3% versus 5.5%, P =0.022) and fewer paravalvular leak (18.2% versus 41.1%; P <0.001) paralleling a longer time-to-reintervention (41.8 versus 19.7 months; P <0.001). Reintervention strategy was nearly identical between groups (redo TAVR 54.4% failed-BEV versus 53.6% failed-SEV; TAVR-explant 45.6% versus 46.4%; P =0.92), with cross-platform redo-TAVR favored in both groups (58.1% of failed-BEV received SEV; 59.2% of failed-SEV received BEV; P =0.016). Compared with failed-SEV, reintervention for failed-BEV had similar mortality at 30 days (8.7% versus 8.0%; P =0.85) and 1 year (24.3% versus 21.5%; P =0.65), with no differences in risk-adjusted 3-year cumulative mortality when stratified by reintervention type (redo TAVR: adjusted hazard ratio, 1.15 [0.61–2.20]; ref: failed-BEV); TAVR-explant: adjusted hazard ratio, 0.84 [0.46–1.54]). CONCLUSIONS: Failed-BEV and failed-SEV showed distinct failure mechanisms and timing of reintervention, but initial valve type did not impact reintervention strategy or survival after redo-TAVR or TAVR-explant.

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Journal
Circulation Cardiovascular Interventions
Published
2026-09-11
DOI
https://doi.org/10.1161/circinterventions.126.016705
Primary Topic
Cardiac Valve Diseases and Treatments
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article

Impact of Initial Valve Type on Reintervention for TAVR Failure: From the EXPLANTORREDO-TAVR International Registry

Tsuyoshi Kaneko, Igor Belluschi, Syed Zaid, Rik Adrichem et al.
Circulation Cardiovascular Interventions
Cardiac Valve Diseases and Treatments
article

Impact of Initial Valve Type on Reintervention for TAVR Failure: From the EXPLANTORREDO-TAVR International Registry

Tsuyoshi Kaneko, Igor Belluschi, Syed Zaid, Rik Adrichem, Tamim Nazif, Emily Shih, Jörg Kempfert, Michael J. Mack, Ole De Backer, Paolo Denti, Christian C. Schults, Vinayak Bapat, Gilbert H.L. Tang, Keti Vitanova, Joshua D. Rovin, Markus Mach, Sachin S. Goel, Thomas Modine, Martin B. Leon, Moritz Wyler von Ballmoos, Joshua B Goldberg, Oliver Bhadra, John K. Forrest, George Petrossian, Nimesh D. Desai, Howard C. Herrmann, David Meier, Hendrik Ruge, Ron Waksman, Christian Hagl, Axel Unbehaun, Walid Ben-Ali, Mohamed Abdel-Wahab, Philipp Kiefer, Basel Ramlawi, Silvia Corona, Luigi Pirelli, Michael J. Reardon, Hasan Ahmad, Maurizio Taramasso, Arnar Geirsson, Lin Wang, J. Michael DiMaio, Chad A. Kliger, Thijmen W. Hokken, Lenard Conradi, Shekhar Saha, Mateo Marin-Cuartas, Marco Di Eusanio, Andrea Colli, John G. Webb, Nicolas Van Mieghem, Shinichi Fukuhara, Molly Szerlip, Neal S. Kleiman, Martin Andreas, Anson Cheung, Newell Robinson, Anita W. Asgar
article en

Abstract

BACKGROUND: As transcatheter aortic valve replacement (TAVR) expands to younger patients, there is limited data on the impact of TAV type on outcomes of TAVR-explant and redo-TAVR for TAVR failure. We sought to compare outcomes of reintervention for failed balloon-expandable valves (BEV) versus self-expanding valves (SEV). METHODS: From May 2009 to February 2022, 553 patients from 29 centers in the international EXPLANTORREDO-TAVR registry underwent redo-TAVR or TAVR-explant for TAVR failure during a separate admission from index TAVR. Mechanically expanding valves and explantation for endocarditis were excluded. 158 (41.4%) failed-BEV were compared with 224 (58.6%) failed-SEV, and outcomes were reported at 30 days and 1 year. RESULTS: Mean age at reintervention was 75.5±9.3 years, and 40.6% were female. Failed-BEV had higher proportion of structural valve deterioration (73.4% versus 46.1% in failed-SEV; P <0.001) and prosthesis–patient mismatch (12.3% versus 5.5%, P =0.022) and fewer paravalvular leak (18.2% versus 41.1%; P <0.001) paralleling a longer time-to-reintervention (41.8 versus 19.7 months; P <0.001). Reintervention strategy was nearly identical between groups (redo TAVR 54.4% failed-BEV versus 53.6% failed-SEV; TAVR-explant 45.6% versus 46.4%; P =0.92), with cross-platform redo-TAVR favored in both groups (58.1% of failed-BEV received SEV; 59.2% of failed-SEV received BEV; P =0.016). Compared with failed-SEV, reintervention for failed-BEV had similar mortality at 30 days (8.7% versus 8.0%; P =0.85) and 1 year (24.3% versus 21.5%; P =0.65), with no differences in risk-adjusted 3-year cumulative mortality when stratified by reintervention type (redo TAVR: adjusted hazard ratio, 1.15 [0.61–2.20]; ref: failed-BEV); TAVR-explant: adjusted hazard ratio, 0.84 [0.46–1.54]). CONCLUSIONS: Failed-BEV and failed-SEV showed distinct failure mechanisms and timing of reintervention, but initial valve type did not impact reintervention strategy or survival after redo-TAVR or TAVR-explant.

Circulation Cardiovascular Interventions
Houston Methodist (US), Michael E. DeBakey VA Medical Center (US), Abbott Northwestern Hospital (US), Mount Sinai Health System (US), Washington University in St. Louis (US), Columbia University Irving Medical Center (US), Copenhagen University Hospital (DK), Rigshospitalet (DK), San Raffaele University of Rome (IT), Heart Hospital Baylor Plano (US), Hôpital Cardiologique du Haut-Lévêque (FR)
Good health and well-being
Openalex Percentile: Top 11%
Cardiac Valve Diseases and Treatments
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