{
    "abstract": "Despite ever-growing adoption of transcatheter aortic valve replacement (TAVR) in younger healthier patients, a limited number of studies have described post-TAVR valve reinterventions such as surgical explantation known as \"TAVR explant\".\nWe performed a systematic review to characterize the current state of TAVR explant in patients with a failing transcatheter heart valve (THV) using data published by April 30, 2024 in compliance with the PRISMA and MOOSE reporting guidelines. The protocol was registered in PROSPERO (CRD42024529188).\nTwenty-eight studies met the eligibility criteria. Almost all studies were non-randomized, observational, and retrospective. The incidence of TAVR explant ranged from 0.2% to 2.8% in patients with a mean age of 67.3-79.0 years, and women representing 25.0-47.1% of cases. The mean time between TAVR implant and explant was 17.0-674.9 days, with most studies reporting a mean time <365 days. Whereas the Society of Thoracic Surgeons-Predicted Risk of Mortality (STS-PROM) score at the time of the TAVR implant ranged between 2.6% and 7.7% (with only one study with score >5%), the STS-PROM score at the time of the TAVR explant ranged between 3.9% and 9.9% (with 17 studies with score >5%). Isolated surgical aortic valve replacement (SAVR) happened in 16.2-100% of cases, aortic root replacement was required in 2.6-41.2%, ascending aortic replacement was performed in 3.2-33.3% of cases. Mitral valve repair/replacement was necessary in 11.8-43.5% and tricuspid valve/repair replacement was done in 2.8-25.0%. Stroke rates were between 0.0% and 20.0% with most studies with rates above 4.0%. The 30-day death rate ranged from 4.8% to 50.0% with most studies with mortality rates higher than 10%. Observed-to-expected mortality ratio was higher than 1.0 in almost all the studies that reported this variable.\nTAVR explant remains a rare event, but its clinical impact is non-negligible. Lifetime management strategies should be adopted in younger lower-risk patients when choosing THVs for the index TAVR.",
    "authors": [
        {
            "affiliation": "Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.",
            "firstname": "Michel Pompeu",
            "initials": "MP",
            "lastname": "S\u00e1"
        },
        {
            "affiliation": "Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.\nUPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.",
            "firstname": "Eishan",
            "initials": "E",
            "lastname": "Ashwat"
        },
        {
            "affiliation": "Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.",
            "firstname": "Xander",
            "initials": "X",
            "lastname": "Jacquemyn"
        },
        {
            "affiliation": "Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.\nUPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.",
            "firstname": "Danial",
            "initials": "D",
            "lastname": "Ahmad"
        },
        {
            "affiliation": "Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.\nUPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.",
            "firstname": "James A",
            "initials": "JA",
            "lastname": "Brown"
        },
        {
            "affiliation": "Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.\nUPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.",
            "firstname": "Derek",
            "initials": "D",
            "lastname": "Serna-Gallegos"
        },
        {
            "affiliation": "Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.",
            "firstname": "Asishana",
            "initials": "A",
            "lastname": "Osho"
        },
        {
            "affiliation": "Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.",
            "firstname": "Jordan P",
            "initials": "JP",
            "lastname": "Bloom"
        },
        {
            "affiliation": "Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.\nUPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.",
            "firstname": "Ibrahim",
            "initials": "I",
            "lastname": "Sultan"
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2025 AME Publishing Company. All rights reserved.",
    "doi": "10.21037/acs-2024-etavr-0075\n10.1056/NEJMoa1514616\n10.1056/NEJMoa1700456\n10.1056/NEJMoa1814052\n10.1056/NEJMoa1816885\n10.1001/jamacardio.2020.4738\n10.1161/CIRCINTERVENTIONS.116.003930\n10.1016/j.jacc.2020.02.051\n10.1161/JAHA.118.010027\n10.1016/j.jcin.2020.04.029\n10.1016/j.xjtc.2020.06.018\n10.1016/j.jacc.2020.08.048\n10.1016/j.jcin.2021.07.015\n10.1016/j.jtcvs.2019.11.139\n10.1161/CIRCINTERVENTIONS.120.009927\n10.1161/CIRCULATIONAHA.120.050499\n10.1016/j.athoracsur.2020.06.138\n10.1016/j.athoracsur.2021.01.041\n10.1136/bmj.n71\n10.1001/jama.283.15.2008\n10.1016/j.jclinepi.2012.09.016\n10.4244/EIJ-D-23-00722\n10.1016/j.jcin.2024.01.292\n10.1016/j.athoracsur.2024.03.024\n10.1016/j.athoracsur.2023.05.036\n10.1016/j.jcin.2023.01.376\n10.3390/jcm12165177\n10.1016/j.jcin.2023.03.015\n10.1016/j.athoracsur.2023.03.040\n10.1016/j.jtcvs.2021.03.130\n10.1016/j.jtcvs.2021.08.057\n10.1016/j.jtcvs.2023.04.029\n10.1016/j.athoracsur.2022.09.028\n10.1016/j.jtcvs.2021.12.060\n10.1016/j.amjcard.2022.07.026\n10.1016/j.athoracsur.2021.10.022\n10.1007/s00380-022-02119-7\n10.1111/jocs.16784\n10.1016/j.ijcard.2020.10.038\n10.1161/CIRCINTERVENTIONS.119.007938\n10.1016/j.echo.2015.07.003\n10.1016/s0735-1097(00)01113-x\n10.1016/j.athoracsur.2011.06.092\n10.1016/j.carpath.2011.05.003\n10.1161/JAHA.123.033176\n10.1016/j.jtcvs.2007.12.002\n10.1016/j.shj.2022.100118\n10.1002/ccd.30562\n10.1002/ccd.30666\n10.1016/j.jacc.2019.06.012\n10.1016/j.jcin.2020.03.052\n10.1111/jocs.16110\n10.1161/JAHA.121.024848\n10.1016/j.jcin.2020.10.020",
    "journal": "Annals of cardiothoracic surgery",
    "keywords": [
        "Heart valve prosthesis implantation",
        "cardiac surgical procedures",
        "cardiovascular surgical procedures",
        "heart valves"
    ],
    "methods": null,
    "publication_date": "2025-04-24",
    "pubmed_id": "40270844\n27040324\n28304219\n30883058\n30883053\n33031491\n27578840\n32327098\n30371173\n32535005\n34317819\n33059830\n34556271\n32037245\n33719506\n33284653\n32979373\n33545150\n33782057\n10789670\n23337781\n38224255\n38573257\n38580202\n37354965\n37100556\n37629220\n37100557\n37121292\n34364682\n34538638\n37164056\n36179856\n35525801\n36075751\n34800488\n35802181\n35870159\n33144095\n31694412\n26275752\n11216982\n21944438\n21816627\n38533939\n18374749\n37275584\n36655511\n37070459\n31319919\n32646692\n34697831\n36533610\n33478639",
    "results": "Twenty-eight studies met the eligibility criteria. Almost all studies were non-randomized, observational, and retrospective. The incidence of TAVR explant ranged from 0.2% to 2.8% in patients with a mean age of 67.3-79.0 years, and women representing 25.0-47.1% of cases. The mean time between TAVR implant and explant was 17.0-674.9 days, with most studies reporting a mean time <365 days. Whereas the Society of Thoracic Surgeons-Predicted Risk of Mortality (STS-PROM) score at the time of the TAVR implant ranged between 2.6% and 7.7% (with only one study with score >5%), the STS-PROM score at the time of the TAVR explant ranged between 3.9% and 9.9% (with 17 studies with score >5%). Isolated surgical aortic valve replacement (SAVR) happened in 16.2-100% of cases, aortic root replacement was required in 2.6-41.2%, ascending aortic replacement was performed in 3.2-33.3% of cases. Mitral valve repair/replacement was necessary in 11.8-43.5% and tricuspid valve/repair replacement was done in 2.8-25.0%. Stroke rates were between 0.0% and 20.0% with most studies with rates above 4.0%. The 30-day death rate ranged from 4.8% to 50.0% with most studies with mortality rates higher than 10%. Observed-to-expected mortality ratio was higher than 1.0 in almost all the studies that reported this variable.",
    "title": "The current state of transcatheter aortic valve replacement explant: an updated systematic review.",
    "xml": "<Element 'PubmedArticle' at 0x788503e518a0>"
}