Transcatheter aortic valve replacement explantation experience in Japanese high-volume center

Transcatheter aortic valve replacement (TAVR) explant is an essential therapeutic option for late-stage biological valve failure (BVF) or prosthetic valve endocarditis (PVE) following TAVR, though poor outcomes have been reported. This study assesses TAVR explant outcomes at a high-volume Japanese center.

From October 2009 to December 2023, 10 TAVR explants were performed after 1,364 TAVR procedures at a leading Japanese high-volume center, and clinical outcomes were retrospectively analyzed. Data were drawn from a prospectively maintained database, assessing preoperative and intraoperative variables, as well as short- and long-term postoperative outcomes.

Thirty-nine BVFs were observed during follow-up, and 16 (41.0%) redo-TAVRs were performed in the same timeframe. In the 10 (25.6%) TAVR explant cases, the median age of the patients was 79.5 years, with a predicted mortality for isolated surgical aortic valve replacement (SAVR) by Society of Thoracic Surgeons (STS) score of 4.5%. The primary indications for TAVR explant were PVE (40.0%) and structural valve deterioration (SVD) (30.0%). Concomitant procedures were necessary in 90% of cases, including aortic repair (40.0%) and mitral replacement or repair (30.0%). Aortic annulus reinforcement using autologous pericardium was performed in 30% of cases. The 30-day mortality rate was 20%, with 20% of cases requiring temporary mechanical circulatory support and postoperative continuous hemodiafiltration. In mid-term outcomes, the survival rate was 60% in 1 year and 40% in 3 years, respectively.

In this Japanese high-volume center experience, TAVR explants predominantly involved elderly patients and frequently required a concomitant procedure. The outcome was generally poor, comparable to those in Western countries. As the number of TAVR explants is expected to increase in Japan, knowledge-sharing within heart teams, including cardiac surgeons, is essential.