Valve Type and Operative Risks in Surgical Explantation of Transcatheter Aortic Valves: A Systematic Review and...

Area of Science:

• Cardiology
• Cardiac Surgery
• Interventional Cardiology

Background:

• Transcatheter aortic valve replacement (TAVR) procedures are increasing, leading to more frequent indications for surgical explantation.
• Patients undergoing TAVR are often living longer, increasing the complexity and risk associated with repeat procedures.

Purpose of the Study:

• To conduct a systematic review and meta-analysis to identify factors influencing outcomes of TAVR explantation.
• To quantify the mortality and morbidity associated with surgical TAVR explantation.

Main Methods:

• Systematic review and meta-analysis with meta-regression.
• Searched MEDLINE and Embase databases for relevant studies.
• Included twelve eligible studies meeting predefined criteria.

Main Results:

• Surgical TAVR explantation is associated with high 30-day mortality (17%) and significant morbidity, including stroke (5%) and kidney injury (16%).
• The type of transcatheter valve used in the initial TAVR procedure did not impact outcomes after surgical explantation.
• The incidence of these high-risk procedures is increasing.

Conclusions:

• Surgical explantation of TAVR is a high-risk procedure with substantial mortality and morbidity.
• Current data suggest valve type does not influence explantation outcomes.
• There is a growing need for specialized risk stratification tools for these complex cardiac surgeries.