Abstract:
BACKGROUND:Currently, there is a paucity of information on surgical explantation after transcatheter aortic valve replacement (TAVR). OBJECTIVES:The purpose of this study was to examine the incidence, patient characteristics, predictors, and outcomes of surgical explantation after TAVR using a population-based, nationally representative database. METHODS:We analyzed the Medicare Provider profile to include all U.S. patients undergoing TAVR from 2012 to 2017. Time to surgical explant was calculated from the index TAVR discharge to surgical explantation. Post-operative survival was assessed using time-dependent Cox proportional hazard regression analysis and landmark analysis. RESULTS:The incidence of surgical explantation was 0.2% (227 of 132,633 patients), and was 0.28% and 0.14% in the early and newer TAVR era, respectively. The median time to surgical explant was 212 days, whereas 8.8% and 70.9% underwent surgical explantation within 30 days and 1 year, respectively. The primary indication for reintervention was bioprosthetic failure (79.3%). Compared with the no-explant cohort, the explant cohort was significantly younger (mean age 73.7 years vs. 81.7 years), with a lower prevalence of heart failure (55.9% vs. 65.8%) but more likely a lower-risk profile cohort (15% vs. 2.4%; all p < 0.05). The 30-day and 1-year mortality rates were 13.2% and 22.9%, respectively, and did not vary by either time to surgical explant or TAVR era, or between patients with versus without endocarditis (all p > 0.05). The time-dependent Cox regression analysis demonstrated a higher mortality in those with surgical explantation (hazard ratio: 4.03 vs. no-explant group; 95% confidence interval: 1.81 to 8.98). Indication, time-to-surgical-explant, and year of surgical explantation were not associated with worse post-explantation survival (all p > 0.05). CONCLUSIONS:The present study provides updated evidence on the incidence, timing, and outcomes of surgical explantation of a TAVR prosthesis. Although the overall incidence was low, short-term mortality was high. These findings stress the importance of future mechanistic studies on TAVR explantation and may have implications on lifetime management of aortic stenosis, particularly in younger patients.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Hirji SA,Percy ED,McGurk S,Malarczyk A,Harloff MT,Yazdchi F,Sabe AA,Bapat VN,Tang GHL,Bhatt DL,Thourani VH,Leon MB,O'Gara P,Shah PB,Kaneko Tdoi
10.1016/j.jacc.2020.08.048subject
Has Abstractpub_date
2020-10-20 00:00:00pages
1848-1859issue
16eissn
0735-1097issn
1558-3597pii
S0735-1097(20)36437-8journal_volume
76pub_type
杂志文章abstract:OBJECTIVES:We sought to determine the physiologic actions and potential therapeutic applications of mutant atrial natriuretic peptide (mANP). BACKGROUND:The cardiac hormone atrial natriuretic peptide (ANP) is a 28-amino acid (AA) peptide that consists of a 17-AA ring structure together with a 6-AA N-terminus and a 5-A...
journal_title:Journal of the American College of Cardiology
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doi:10.1016/j.jacc.2009.04.080
更新日期:2009-09-08 00:00:00
abstract::Recent experimental studies show that the opioid system is important to the pathophysiology of cardiovascular impairment in congestive heart failure. Plasma beta-endorphin levels were measured in 37 patients with congestive heart failure and compared with those of 21 age- and gender-matched normal subjects. The relati...
journal_title:Journal of the American College of Cardiology
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doi:10.1016/0735-1097(91)90703-c
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abstract:OBJECTIVES:A technique for terminating refractory ventricular fibrillation is described. BACKGROUND:Refractory ventricular fibrillation can occur in up to 0.1% of electrophysiologic studies. Animal studies have shown that rapid sequential shocks may reduce ventricular fibrillation threshold. METHODS:Five patients of ...
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doi:10.1016/0735-1097(94)90602-5
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journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2017-10-24 00:00:00
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更新日期:2017-07-11 00:00:00