Transcatheter heart valve explant with infective endocarditis-associated prosthesis failure and outcomes: the EXPLANT-TAVR international registry
Authors: Marin-Cuartas Mateo , Tang Gilbert H L , Kiefer Philipp , Fukuhara Shinichi , Lange Rudiger , Harrington Katherine B , Saha Shekhar , Hagl Christian , Kleiman Neal S , Goel Sachin S , Kempfert Joerg , Werner Paul , Petrossian George A , Geirsson Arnar , Desai Nimesh D , Chu Michael W A , Bhadra Oliver D , Shults Christian , Garatti Andrea , Vincent Flavien , Grubb Kendra J , Goldberg Joshua B , Mack Michael J , Modine Thomas , Denti Paolo , Kaneko Tsuyoshi , Bapat Vinayak N , Reardon Michael J , Borger Michael A , Zaid Syed ,   EXPLANT-TAVR Investigators, Bruschi Giuseppe , Squiers John J , Szerlip Molly I , DiMaio J Michael , Hirji Sameer , Shah Pinak B , Leroux Lionel , Van Belle Eric , Koussa Mohammad , Nazif Tamim M , George Isaac , Van Mieghem Nicholas M , Hokken Thijmen W , Unbehaun Axel , Vitanova Keti , Atkins Marvin D , Doty John R , Whisenant Brian K , Di Eusanio Marco , Capestro Filippo , Ramlawi Basel , Holzhey David , Noack Thilo , Pirelli Luigi , Brinster Derek R , Algadheeb Muhanad , Bagur Rodrigo , Di Virgilio Antonio , Salinger Michael H , Andreas Martin , Satler Lowell F , Waksman Ron , Ali Walid Ben , Ibrahim Reda , Demers Philippe , Rovin Joshua , Voisine Pierre , Mohammadi Siamak , Rodés-Cabau Josep , Gelpi Guido , Belluschi Igor , Maisano Francesco , Robinson Newell B , Wang Lin , Ouzounian Maral , Conradi Lenard , Estevez-Loureiro Rodrigo , Pinon Miguel A , Wyler von Ballmoos Moritz , Nguyen Tom C , Deeb G Michael , Ruel Marc , Al-Atassi Talal , D’Onofrio Augusto , Tessari Chiara , Bavaria Joseph E , Colli Andrea , Pizano Alejandro , Goel Kashish , Shah Ashish S , Ahmad Hasan A , Forrest John K , Taramasso Maurizio , Gennari Marco 
Published: May 2024

Abstract

Background and Aims
Surgical explantation of transcatheter heart valves (THVs) is rapidly increasing, but there are limited data on patients with THV-associated infective endocarditis (IE). This study aims to assess the outcomes of patients undergoing THV explant for IE.

Methods
All patients who underwent THV explant between 2011 and 2022 from 44 sites in the EXPLANT-TAVR registry were identified. Patients with IE as the reason for THV explant were compared to those with other mechanisms of bioprosthetic valve dysfunction (BVD).

Results
A total of 372 patients from the EXPLANT-TAVR registry were included. Among them, 184 (49.5%) patients underwent THV explant due to IE and 188 (50.5%) patients due to BVD. At the index transcatheter aortic valve replacement, patients undergoing THV explant for IE were older (74.3 ± 8.6 vs. 71 ± 10.6 years) and had a lower Society of Thoracic Surgeons risk score [2.6% (1.8–5.0) vs. 3.3% (2.1–5.6), P = .029] compared to patients with BVD. Compared to BVD, IE patients had longer intensive care unit and hospital stays (P &lt; .05) and higher stroke rates at 30 days (8.6% vs. 2.9%, P = .032) and 1 year (16.2% vs. 5.2%, P = .010). Adjusted in-hospital, 30-day, and 1-year mortality was 12.1%, 16.1%, and 33.8%, respectively, for the entire cohort, with no significant differences between groups. Although mortality was numerically higher in IE patients 3 years postsurgery (29.6% for BVD vs. 43.9% for IE), Kaplan–Meier analysis showed no significant differences between groups (P = .16).

Conclusions
In the EXPLANT-TAVR registry, patients undergoing THV explant for IE had higher 30-day and 1-year stroke rates and longer intensive care unit and hospital stays. Moreover, patients undergoing THV explant for IE had a higher 3-year mortality rate, which did not reach statistical significance given the relatively small sample size of this unique cohort and the reduced number of events.