Analysis of real-world US data comparing outcomes after post-transcatheter aortic valve implantation (TAVI) reinterventions points towards improved long-term survival and freedom from further valve reintervention among patients who have had their TAVI valve explanted surgically than those who underwent a second—redo—TAVI procedure.
“There is a perception that TAVI explant is associated with really dismal outcomes, however I think that the data is really encouraging in terms of a relatively favourable long-term survival,” Shinichi Fukuhara, a cardiac surgeon at the University of Michigan (Ann Arbor, USA), who presented the data at New York Valves 2025 (25–27 June, New York, USA) commented.
Fukuhara’s analysis looked at Medicare fee-for-service beneficiaries who received TAVI between 2011–2024, excluding patients who required same-day reintervention during or after the index procedure. Researchers found a total of 4,443 patients with post-TAVI reinterventions during this timeframe, 2,553 undergoing redo TAVI and 1,890 TAVI explant.
Both procedures are increasing in prevalence, Fukuhara detailed, commenting that the clinical relevance of both interventions is “steeply rising”. However, he noted, there is little understanding of the relative outcomes and longitudinal trajectories of the two approaches.
Detailing baseline characteristics of the two groups, Fukuhara detailed that there were unsurprisingly, differences among the two groups, with redo TAVI patients typically older, and with a higher prevalence of comorbidities including diabetes and kidney failure. The TAVI explant group had a significantly higher rate of endocarditis.
“Not surprisingly, 30-day mortality was significantly higher in the TAVI-explant group, reaching above 15%,” Fukuhara detailed, outlining the unadjusted survival rate after reintervention. “Despite this unfavourable short-term survival in the TAVI-explant group, the long-term survival was significantly better in the TAVI explant group, with the crossover point at 1.8 years.”
This result was consistent when the researchers adjusted for survival and excluded endocarditis cases.
When the researchers adjusted their analysis to stratify outcomes by age at the time of the index TAVI procedure, they found that among those aged between 65–70 years, TAVI explant demonstrated significantly improved survival after four years, with a crossover point between the two approaches at 1.3 years. Among older patients, those aged 70–80 or >80 years, this survival difference was no longer seen.
“Post-TAVI reinterventions remain very infrequent long-term,” Fukuhara said of the data, acknowledging that both redo TAVI and TAVI explant are steadily increasing. “TAVI explant is associated with an improved long-term survival and freedom from second valve reintervention compared with redo TAVI,” he concluded.
“These are patients that have, for whatever reason, some sort of hostile situation towards the TAVI,” Michael Borger (Leipzig Heart Center, Leipzig, Germany), who was a
discussant at New York Valves for Fukuhara’s presentation, commented of the findings. “I think it is not terribly surprising if we add more hostility to an already hostile situation we are not going to have good long-term results.”
Fukuhara responded that the two approaches are not “mutually exclusive” and it is important to consider the individual characteristics of each patient.However, he said, many patients who have anatomy suitable for redo TAVI may tolerate TAVI explant well.
Speakers highlighted, however, that the surgical approach to removing valves can carry a steep learning curve, with Fukuhara commented that it is the “modern cardiac surgeon’s duty” to improve the safety and outcomes associated with the procedure, noting that timing of the procedure is also important.
“I always talk about this at the surgical meetings, the learning curve of TAVI explant is not only the technique, how to explant TAVI safely, but also timely intervention,” Fukuhara said. “Patients who did not do well after TAVI explant are typically someone who waited and waited, explored some other non-surgical options, and they end up with renal failure and heart failure—those are the patients who did not do well. Timely explant procedures I believe will yield excellent outcomes.”
