As transcatheter aortic valve replacement (TAVR) expands to younger patients with longer life expectancy, management of failed transcatheter valves is becoming increasingly relevant. A registry analysis published in Circulation: Cardiovascular Interventions evaluated whether the mechanism of valve failure influences outcomes after redo-TAVR or TAVR explant.

From 553 patients in the EXPLANTORREDO-TAVR registry treated across 29 centers between 2009 and 2022, patients with endocarditis were excluded. The comparative analysis included 224 patients with structural valve deterioration (SVD) and 121 with nonstructural valve dysfunction (NSVD), including paravalvular leak and prosthesis-patient mismatch. The mean age was 75.6 years, and 42% were women.

Reintervention type did not differ significantly between groups (redo-TAVR: 58.0% vs 49.6%; explant: 42.0% vs 50.4%; P = .14). SVD had a longer time to reintervention than NSVD (50.7 vs 5.5 months; P < .001) and was more common in balloon-expandable valves (50.7% vs 24.8%; P < .001).

For redo-TAVR, 30-day mortality was 3.2% vs 1.7%, and 1-year mortality was 18.0% vs 12.0% for SVD vs NSVD. For explant, 30-day mortality was 16.3% vs 12.1%, and 1-year mortality was 40.0% vs 29.5%. Adjusted 3-year mortality was also similar for redo-TAVR (HR 1.30; 95% CI, 0.68-2.46) and explant (HR 1.24; 95% CI, 0.64-2.41).

These findings suggest the valve failure mechanism may influence timing and device patterns, but was not associated with significant outcome differences after reintervention.