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Publications

Journal Article Ahead of print

PubMed: 42057182 DOI: 10.1186/s13019-026-04137-2

Impact of surgical timing on outcomes after transcatheter aortic valve explantation: insights from a French multicenter retrospective study.

J Cardiothorac Surg

Authors: Maroua Eid, Géraldine Allain, Guillaume Guimbretiere, Pierre Escrig, Kévin Pluchon, Stéphane Kermen, Jacques Tomasi, Christophe Jayle, Jean-Christian Roussel, Eric Bezon, Thierry Bourguignon, Olivier Fouquet

Affiliations

  • Department of Cardiac Surgery, University Hospital of Angers, 4 rue Larrey 49933, Angers Cedex 09, France.
  • Faculty of Medicine, MITOVASC Institute INSERM U1083 UMR-CNRS 6214, University Hospital of Angers, 2 rue Haute de Reculée, Angers Cedex, 49045, France.
  • Department of Cardio-Thoracic and Vascular Surgery, University Hospital of Poitiers, 2 rue de la Milétrie, Poitiers, 86000, France.
  • Department of Thoracic and Cardio-Vascular Surgery, Univeristy Hopital of Nantes, Hôpital Nord Laennec Boulevard Jacques-Monod, Saint-Herblain, Nantes Cedex 1, 44093, France.
  • Department of Thoracic and Cardio-Vascular Surgery, University Hospital of Rennes, 2 rue Henri Le Guilloux, Rennes Cedex 9, 35033, France.
  • Department of Cardio-Thoracic and Vascular Surgery, Boulevard Tanguy Prigent, University Hospital of Brest, Hôpital de la Cavale Blanche, Brest, 29200, France.
  • Department of Cardiac Surgery, Regional University Hospital of Tours, Hôpital Trousseau, Tours Cedex 9, 37044, France.
  • Department of Cardiac Surgery, University Hospital of Angers, 4 rue Larrey 49933, Angers Cedex 09, France.
  • Faculty of Medicine, MITOVASC Institute INSERM U1083 UMR-CNRS 6214, University Hospital of Angers, 2 rue Haute de Reculée, Angers Cedex, 49045, France.

Abstract

BACKGROUND

Surgical explantation of transcatheter aortic valves (TAV-explant) is an emerging but uncommon procedure, increasingly required as TAVI is performed in younger and lower-risk patients. Contemporary evidence on outcomes, timing, and valve type remains limited.

METHODS

We conducted a multicenter retrospective study of patients undergoing surgical TAV-explant. Clinical characteristics, indications, surgical strategies, and outcomes were analyzed. Outcomes were compared according to the interval between index TAVI and explantation (< 1 month, 1-12 months, > 12 months). The indication and the type of initial transcatheter valve (balloon-expandable vs. self-expanding) were also analyzed. The primary outcome was 30-day mortality.

RESULTS

A total of 62 patients were included. Indications for TAV-explantation were predominantly bioprosthetic valve dysfunction (45.2%), infective endocarditis. (21%), and procedural failure (33.9%)The 30-day mortality was 16.1% and did not differ according to the delay of explantation (p = 0.816). Overall mortality did not differ according to the indication of explantation, nor by type of explanted valve. Concomitant aortic surgery was required in 18% of cases. Although EuroSCORE II values were elevated in this cohort, this tool underestimated the operative risk, as it was not designed for complex redo surgery.

CONCLUSIONS

TAV-explantation is technically feasible but remains associated with substantial early mortality. Outcomes are not influenced by the timing of explantation or by valve type. These findings highlight the limitations of current surgical risk scores and underscore the importance of thorough pre-operative planning and Heart Team evaluation. Continued multicenter data collection is essential to optimize patient selection and refine management strategies.

MeSH

Mortality, Retrospective Studies, Aortic Valve, Transcatheter Aortic Valve Replacement