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Transcatheter Heart Valve Explant for Infective Endocarditis
Quick Takes
- Using data from the EXPLANT-TAVR registry (a multicenter, international registry of patients who underwent surgical transcatheter heart valve [THV] explantation), patients who underwent THV explant for infective endocarditis (IE) compared to bioprosthetic valve dysfunction (BVD) had longer ICU and hospital stays and higher stroke rates at 30 days and 1 year.
- There were no statistically significant differences between groups in adjusted in-hospital, 30-day, and 1-year mortality rates, with a nonsignificant trend toward higher mortality at 3 years among patients who underwent explant for THV-IE.
Study Questions:
What are the outcomes of patients undergoing transcatheter heart valve (THV) explant in the setting of THV-associated infective endocarditis (IE)?
Methods:
Data from the EXPLANT-TAVR registry (a multicenter, international registry of patients who underwent surgical THV explantation at one of 44 centers around the world) were used to identify patients who underwent THV explant between 2011 and 2022. Clinical outcomes for patients with IE as the reason for THV explant were compared with those for patients who underwent THV explant for 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%) due to BVD. At the index transcatheter aortic valve replacement (TAVR), 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 = 0.029) compared to patients with BVD. Compared to BVD, IE patients had longer intensive care unit (ICU) and hospital stays (p < 0.05) and higher stroke rates at 30 days (8.6% vs. 2.9%, p = 0.032) and 1 year (16.2% vs. 5.2%, p = 0.010). Adjusted in-hospital, 30-day, and 1-year mortality rates were 12.1%, 16.1%, and 33.8%, respectively, for the entire cohort with no significant differences between groups. Although 3-year postoperative mortality was numerically higher in IE patients (43.9% for IE [18 patients at risk] vs. 29.6% for BVD [27 patients at risk]), Kaplan–Meier analysis showed no significant differences between groups (p = 0.16).
Conclusions:
In the EXPLANT-TAVR registry, patients undergoing THV explant for IE compared to BVD had longer ICU and hospital stays and higher 30-day and 1-year stroke rates with no significant differences between groups in adjusted in-hospital, 30-day, and 1-year mortality rates. Although there was a trend toward higher 3-year mortality among patients undergoing THV explant for IE, this did not reach statistical significance possibly owing to the relatively small sample size.
Perspective:
Data from this large, multicenter, international registry document longer ICU and hospital stays and higher 30-day and 1-year rates of stroke among patients who undergo THV explant in the setting of THV-IE compared to THV explant for BVD, but similar rates of mortality at least through 1 year. Only a minority of patients with THV-IE typically undergo surgical reintervention, presumably related to advanced age and comorbidities. Although of interest for its comparison of patient groups who underwent THV explant for two different indications, this analysis did not address the rationale for or against reintervention, decisions regarding surgical versus repeat transcatheter intervention, or clinical outcomes of the larger group of patients with unoperated THV-IE.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Cardiac Surgery and VHD, Interventions and Structural Heart Disease
Keywords: Cardiac Surgical Procedures, Endocarditis, Bacterial, Heart Valve Diseases
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