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Transcatheter Heart Valve Explant With Infective Endocarditis-Associated Prosthesis Failure and Outcomes: The EXPLANT-TAVR International Registry

Wednesday, June 5, 2024

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Mateo Marin-Cuartas, Gilbert H L Tang, Philipp Kiefer, Shinichi Fukuhara, Rudiger Lange, Katherine B Harrington, Shekhar Saha, Christian Hagl, Neal S Kleiman, Sachin S Goel, Joerg Kempfert, Paul Werner, George A Petrossian, Arnar Geirsson, Nimesh D Desai, Michael W A Chu, Oliver D Bhadra, Christian Shults, Andrea Garatti, Flavien Vincent, Kendra J Grubb, Joshua B Goldberg, Michael J Mack, Thomas Modine, Paolo Denti, Tsuyoshi Kaneko, Vinayak N Bapat, Michael J Reardon, Michael A Borger, Syed Zaid

Surgical explantation of transcatheter heart valves (THV) is rapidly increasing, but data on patients with THV-associated infective endocarditis (IE) is lacking. This study assessed the outcomes of patients undergoing THV explant for IE based on data from the international TAVR-EXPLANT Registry. 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). A total of 372 patients were included. Among them, 184 (49.5 percent) patients underwent THV explant due to IE and 188 (50.5 percent) patients due to BVD. Compared to BVD, IE patients had longer intensive care unit and hospital stays (P < 0.05) and higher stroke rates at 30 days (8.6 percent vs. 2.9 percent, P = 0.032) and 1 year (16.2 percent vs. 5.2 percent, P = 0.010). Adjusted in-hospital, 30-day, and one-year mortality was 12.1 percent, 16.1 percent, and 33.8 percent, respectively, for the entire cohort, with no significant differences between groups. Although mortality was numerically higher in IE patients three years following surgery (29.6 percent for BVD vs. 43.9 percent for IE), Kaplan–Meier analysis showed no statistically significant differences between groups (P = 0.16).

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