The current state of transcatheter aortic valve replacement explant: an updated systematic review

Introduction

Transcatheter aortic valve replacement (TAVR) is a well-established alternative to surgical aortic valve replacement (SAVR) for patients with severe symptomatic aortic stenosis (1-4). Additionally, the further expansion of TAVR indications includes not only high-risk patients, but also those at intermediate/low risk (based on the results of pivotal trials) and those with bicuspid aortic valves [after approval by the Food and Drug Administration (FDA) despite the exclusion of patients with this specific anatomy from the trials] (5).

With the ever-growing adoption of TAVR in younger healthier patients, significant changes in aortic valve reintervention procedures are expected soon, but a limited number of studies have described post-TAVR valve reinterventions, either TAVR-in-TAVR procedures (6,7) or surgical transcatheter heart valve (THV) explantation (“TAVR explant”) (8-17). Of particular concern, are the consistently poor outcomes in patients requiring TAVR explant and this scenario remains underexplored.

In this context, we conducted a systematic review using the existing evidence to characterize the current state of TAVR explant in patients with a failing THV.

Methods

Protocol

This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline (18) and the Meta-Analysis Of Observational Studies in Epidemiology (MOOSE) reporting guideline (19). The protocol was registered in PROSPERO (CRD42024529188).

All observational studies and case series reporting TAVR explant were searched for using a two-level search strategy. First, MEDLINE/PubMed, Embase, Scopus, Web of Science, CCTR/CENTRAL, LILACS, SciELO were searched through April 30, 2024. Second, relevant studies were identified through a manual search of secondary sources including references of initially identified articles, reviews, and commentaries. All references were downloaded for consolidation, elimination of duplicates, and further analyses. The search terms included “failed transcatheter heart valves”, “structural valve deterioration”, “structural valve degeneration”, “endocarditis”, “transcatheter aortic valve replacement”, “transcatheter aortic valve implantation”, “TAVR”, “TAVI”, “explant”, “explantation” and “reoperation”. Two independent and blinded authors (X.J., D.A.) reviewed the search results separately to select the studies based on the inclusion and exclusion criteria. Any discrepancies were resolved by discussion and consensus with a third author (M.P.S.). There were no language restrictions.

Studies that met the following criteria were included: the study design was an observational study or a case series, and the study population included adults who underwent TAVR explant for any reason (except for cases with an intraoperative conversion from TAVR to SAVR). The risk of bias in the individual studies was reviewed using the Joanna Briggs Institute Critical Appraisal Checklist (20).

The following information was extracted: authors, year of publication, sample size, frequency of TAVR explant, age, time between TAVR valve implant and explant, Society of Thoracic Surgeons-Predicted Risk of Mortality (STS-PROM), and New York Heart Association (NYHA) class III/IV heart failure at the time of TAVR valve implant and explant, previous cardiac surgery, clinical indications for TAVR explant, type of explanted TAVR valve and implanted surgical valve, concomitantly performed procedures in addition to SAVR, cardiopulmonary bypass (CPB) and aortic cross-clamp times, 30-day mortality, length of intensive care unit (ICU) stay and hospital stay, 30-day readmission, reoperation for bleeding, stroke, renal failure, and new permanent pacemaker implantation (PPI).

Continuous variables are expressed as mean ± standard deviation (SD) or median [interquartile range (IQR)], as appropriate for the data distribution. Categorical variables are expressed as frequency and percentage.

Given the nature of this study, Institutional Research Board approval and patient-informed written consent for publication were not required.

Results

Study selection and characteristics

After excluding non-eligible studies, 28 studies (8-14,16,17) met the eligibility criteria (21-39) (Figure 1). Almost all studies were non-randomized, observational, and retrospective. Table S1 shows the risk of bias in the individual studies using the Joanna Briggs Institute Critical Appraisal Checklist. Most data were obtained from the Michigan experience (13-15,17,28-32), STS Database (9,23,27), EXPLANT-TAVR (21,24,33) and EXPLANTORREDO-TAVR registries (25), the Infectious Endocarditis after TAVR International Registry (39), the Nationwide Readmission Database (38), the Centers for Medicare and Medical Services (CMS) (11) and Medtronic-funded studies (22) [pooled data from CoreValve and Evolut R/PRO randomized trials and single-arm studies; the CoreValve US Pivotal Extreme-Risk and High-Risk trials (NCT01240902) and Continued Access Studies (NCT01531374); SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) randomized trial and Continued Access Studies (NCT01586910); Evolut R US study (NCT02207569); Evolut R US–34R addendum (NCT02746809); Evolut PRO US study (NCT02738853); and Evolut Low Risk randomized trial (NCT02701283)] and other studies.

Figure 1 Flow diagram of studies included in data search. SAVR, surgical aortic valve replacement; TAVR, transcatheter aortic valve replacement.

Patients’ baseline characteristics

Table 1 shows the patients’ baseline characteristics. Among those studies which reported the incidence of need for TAVR explant, the rate ranged from 0.2% to 2.8%, with most studies reporting incidences <1.0%. Mean age ranged between 67.3 and 79.0 years, with almost all studies showing mean age over 71.0 years. Females represented 25.0–47.1% of cases and the mean time between TAVR implant and explant ranged between 17.0 and 674.9 days, with most studies reporting a mean time <365 days. Whereas the STS-PROM score at the time of the TAVR implant ranged between 2.6% and 7.7% (with only one study with score >5%), the STS-PROM score at the time of the TAVR explant ranged between 3.9% and 9.9% (with 17 studies with score >5%). We found a high prevalence of previous cardiac surgery (14.9–61.9%). Regarding types of THVs, the prevalence of balloon-expandable valves (BEVs) ranged between 15.0–100% and self-expanding valves (SEVs) ranged from 15.4–100%.

Indications for TAVR explant

Table 2 shows the indications for TAVR explant. The major indications were failed implantation (2.9–35.9%), paravalvular leak (PVL) (7.7–71.4%), endocarditis (5.9–100.0%) or structural valve deterioration (3.2–64.0%).

Procedural characteristics

Table 3 shows the procedural characteristics for TAVR explant. Isolated SAVR was performed in 16.2–100% of cases. Aortic root replacement was required in 2.6–41.2%, and ascending aortic replacement was performed in 3.2–33.3% of cases. Mitral valve repair/replacement was necessary in 11.8–43.5% and tricuspid valve/repair replacement was done in 2.8–25.0%. Coronary artery bypass graft (CABG) surgery was performed in 5.9–33.3%. Regarding types of surgical valves implanted after TAVR explant, most valves were bioprosthetic (74.5–100.0%). Mean CPB and aortic cross times ranged between 107.0–228.5 and 80.6–168.0 minutes, respectively.

Procedural outcomes

Table 4 shows the procedural outcomes after TAVR explant. The 30-day death rate ranged from 4.8% to 50.0% with most studies with mortality rates higher than 10%. Observed-to-expected mortality ratio was higher than 1.0 in almost all the studies that reported this variable. Stroke rates were between 0.0% and 20.0% with most studies with rates above 4.0%. Reoperation for bleeding/cardiac tamponade varied from 0.0% to 13.8% and renal failure ranged between 8.0% and 53.3%. New PPI rates ranged between 6.1% and 18.4% and 30-day readmission rates ranged from 5.9% and 36.7%.

Discussion

Summary of evidence

This is the largest systematic review describing characteristics and outcomes of TAVR explant in patients with failing THVs. The most important findings in the present study are the following (Figure 2):

• The overall frequency of TAVR explant is low, with most cases occurring within the first year after the index TAVR;
• The main indications for TAVR explant are failed implantation, PVL, endocarditis, and structural valve deterioration;
• STS-PROM score was higher at the time of TAVR explant than at the time of the prior TAVR implant, with a high prevalence of previous cardiac surgery (for example, as in Figure 3, showing a TAVR explant in a patient who had undergone valve-in-valve TAVR after a previous SAVR);
• Both BEV and SEV lead to TAVR explants;
• There are significant rates of aortic root replacement, ascending aortic replacement, and mitral valve repair/replacement at the time of TAVR explants;
• The 30-day death rates are usually higher than 10.0% with observed-to-expected mortality ratio higher than 1.0 in almost all the reports;
• Stroke rates are non-negligible;
• New PPI rates are high;
• Patients are frequently readmitted after discharge at 30 days.

Figure 3 TAVR explant of a balloon-expandable transcatheter heart valve in a patient who underwent previously valve-in-valve TAVR. (A) Exposure of balloon-expandable THV in a failed bioprosthetic valve; (B-E) simultaneous explantation of THV and surgical valve from the aortic annulus; (F) complete removal of both valves from the aortic annulus; this surgical procedure was performed by Dr. Jordan P. Bloom (co-author) at the Massachusetts General Hospital, Harvard Medical School. TAVR, transcatheter aortic valve replacement; THV, transcatheter heart valve.

Figure 2 Graphical abstract. TAVR, transcatheter aortic valve replacement; STS-PROM, Society of Thoracic Surgeons-Predicted Risk of Mortality.

Comments

Although a marked increase in TAVR case volume has been observed, the incidence of TAVR explant seems to be low. However, this observation warrants caution for various reasons. These TAVR explants were mostly early failures, with most cases occurring within the first year after the index TAVR, while we know from the medical literature (40) that early valve failure of surgical bioprostheses is uncommon within the first five years.

Early failures can be caused by (I) accelerated pannus formation which leads to bioprosthetic valvular dysfunction, obstruction through subvalvular extension of pannus, and regurgitation when pannus encroachment restricts leaflets (41-43); (II) structural valve deterioration secondary to rapid calcification [which can be accelerated by concomitant prosthesis-patient mismatch (44)] and leaflet tear or perforation (45). PVL, which is seldom seen in surgical bioprosthetic valves, is also one of the most common causes of failure warranting TAVR explant (46). Additionally, endocarditis after TAVR has been described as a cause of failures (8,26,28,39).

Although the incidence of complications [such as PVL, patient-prosthesis mismatch (PPM), and new PPI after TAVR] are to be reduced with refinements in implantation techniques (47,48) and new-generation THVs, the number of TAVR explant procedures will probably increase owing to late failures in younger lower-risk patients who will likely outlive the THVs.

Concomitant procedures were commonly performed at the time of TAVR explants, which warrants a deeper discussion. This might be explained by the presence or worsening of untreated cardiac diseases at the time of the index TAVR, completely new cardiac lesions absent at the time of the index TAVR, and the need for unplanned procedures during the TAVR explant (the latter possibly being the reason why we observed high rates of aortic root replacements and ascending aortic replacement). Coronary artery disease (49) and mitral/tricuspid valve diseases (50) are highly prevalent in patients undergoing TAVR. Considering these aspects, more careful selection of patients for the index TAVR may be warranted in terms of lifetime management (51) of aortic valve diseases. A question to be answered in the future would be whether there would be any difference in terms of risk and complexity of TAVR explants between different types of THVs (BEVs vs. SEVs). Fukuhara et al. (17) identified a total of 483 patients with documented explanted THV, consisting of 68% BEV patients and 32% SEV patients. During TAVR-explant, 63% of patients required other simultaneous procedures, including aortic repair (27%), mitral procedures (22%), CABG (15%), and tricuspid procedures (7%). Patients with SEVs underwent more frequent ascending aortic replacement (22% vs. 9%; P<0.001) than those with BEVs, whereas the aortic root replacement rate was similar (19% vs. 24%; P=0.22). The overall 30-day mortality was 18% without differences in mortality or other major complications between the groups. Of the 157 patients with isolated SAVR and available STS-PROM score, the observed-to-expected mortality ratio was 2.2.

The observed 30-day death rates were considerably high (more than 10% in most studies). Compared with reported rates for redo SAVR outside the context of TAVR explants, these rates exceed the overall rate of 5.0% reported in studies with information about redo SAVR for failed surgical bioprosthetic valves (52,53). These increased death rates are also expressed in the observed-to-expected mortality ratios >1.0 in almost all the studies and this is even more noticeable if we consider the fact that the STS-PROM score at the time of the TAVR explant was above 5% in most studies, which means that the observed mortality associated with TAVR explants is much higher than the STS-PROM score was able to predict. However, we should bear in mind that Bowdish et al. (23) showed recently that the existing STS-PROM risk models performed poorly in the setting of TAVR explants, which pointed to the necessity of creation of a new risk calculator specifically for TAVR explants. Indeed, the STS used recent national data from the STS Adult Cardiac Surgery Database between 2012 and 2023 to analyze outcomes of SAVR after previous TAVR (54). The analysis of 5,457 patients reported an average growth rate in cardiac surgery after prior TAVR of 150% per year overall and this was much higher since low-risk TAVR approval in 2019. Outcomes were worse with increasing surgical urgency, older age, dialysis dependence, and multiple reoperations. These real-world outcomes underly the updated SAVR after TAVR risk models in the new risk calculator (55), which provides essential data to inform heart team decisions, particularly if TAVR is to be considered for younger age and low-risk patients who may not have been studied in the low-risk trials.

Limitations

This study has several limitations. First, most studies are of retrospective observational nature with varying sample sizes, which reduces the certainty of evidence.

Second, several studies did not report important variables, and certain clinical characteristics were based solely on just a few studies, thus, the interpretation of these results warrants caution.

Third, important factors such as surgical access, anthropometric characteristics, and pharmacological treatments were not consistently recorded and could not be reliably investigated.

Fourth, although we had established initially in our protocol the adoption of a meta-analytical approach to pool the data, we decided to limit ourselves to the systematic review due to the clear existence of overlapping samples in the studies with potential cohort duplications from the same database or different data sources, inter-database duplications, such as between the data belonging to the Michigan experience (13-15,17,28-32), STS Database (9,23,27), EXPLANT-TAVR (21,24,33) and EXPLANTORREDO-TAVR registries (25), and the Nationwide Readmission Database (38) along with the CMS (11).

Conclusions

We described the clinical/procedural characteristics, indications, and outcomes of TAVR explant. Although the rates of TAVR explant remain low, concurrent procedure rates were high at the time of TAVR explant, and the immediate mortality and morbidity are considerable. In this context, it is of paramount importance to focus not only on the periprocedural outcomes following the index TAVR procedures, but also on longer-term aspects. Our systematic review might be used to appropriately select candidates for TAVR, especially those younger lower-risk patients who would probably outlive the THVs implanted at the index TAVR and for whom lifetime management strategies should be adopted.

Acknowledgments

None.

Footnote

Funding: None.

Conflicts of Interest: I.S. receives institutional research support from Abbott, Artivion, Boston Scientific, Edwards, Medtronic, Terumo Aortic. The other authors have no conflicts of interest to declare.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Leon MB, Smith CR, Mack MJ, et al. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med 2016;374:1609-20. [Crossref] [PubMed]
2. Reardon MJ, Van Mieghem NM, Popma JJ, et al. Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med 2017;376:1321-31. [Crossref] [PubMed]
3. Mack MJ, Leon MB, Thourani VH, et al. Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients. N Engl J Med 2019;380:1695-705. [Crossref] [PubMed]
4. Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients. N Engl J Med 2019;380:1706-15. [Crossref] [PubMed]
5. Forrest JK, Ramlawi B, Deeb GM, et al. Transcatheter Aortic Valve Replacement in Low-risk Patients With Bicuspid Aortic Valve Stenosis. JAMA Cardiol 2021;6:50-7. [Crossref] [PubMed]
6. Barbanti M, Webb JG, Tamburino C, et al. Outcomes of Redo Transcatheter Aortic Valve Replacement for the Treatment of Postprocedural and Late Occurrence of Paravalvular Regurgitation and Transcatheter Valve Failure. Circ Cardiovasc Interv 2016;9:e003930. [Crossref] [PubMed]
7. Landes U, Webb JG, De Backer O, et al. Repeat Transcatheter Aortic Valve Replacement for Transcatheter Prosthesis Dysfunction. J Am Coll Cardiol 2020;75:1882-93. [Crossref] [PubMed]
8. Mangner N, Leontyev S, Woitek FJ, et al. Cardiac Surgery Compared With Antibiotics Only in Patients Developing Infective Endocarditis After Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2018;7:e010027. [Crossref] [PubMed]
9. Jawitz OK, Gulack BC, Grau-Sepulveda MV, et al. Reoperation After Transcatheter Aortic Valve Replacement: An Analysis of the Society of Thoracic Surgeons Database. JACC Cardiovasc Interv 2020;13:1515-25. [Crossref] [PubMed]
10. Nakazato T, Toda K, Kuratani T, et al. Redo surgery after transcatheter aortic valve replacement with a balloon-expandable valve. JTCVS Tech 2020;3:72-4. [Crossref] [PubMed]
11. Hirji SA, Percy ED, McGurk S, et al. Incidence, Characteristics, Predictors, and Outcomes of Surgical Explantation After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2020;76:1848-59. [Crossref] [PubMed]
12. Bapat VN, Zaid S, Fukuhara S, et al. Surgical Explantation After TAVR Failure: Mid-Term Outcomes From the EXPLANT-TAVR International Registry. JACC Cardiovasc Interv 2021;14:1978-91. [Crossref] [PubMed]
13. Fukuhara S, Brescia AA, Shiomi S, et al. Surgical explantation of transcatheter aortic bioprostheses: Results and clinical implications. J Thorac Cardiovasc Surg 2021;162:539-547.e1. [Crossref] [PubMed]
14. Brescia AA, Deeb GM, Sang SLW, et al. Surgical Explantation of Transcatheter Aortic Valve Bioprostheses: A Statewide Experience. Circ Cardiovasc Interv 2021;14:e009927. [Crossref] [PubMed]
15. Fukuhara S, Brescia AA, Deeb GM. Surgical Explantation of Transcatheter Aortic Bioprostheses: An Analysis From the Society of Thoracic Surgeons Database. Circulation 2020;142:2285-7. [Crossref] [PubMed]
16. Malvindi PG, Lorusso R, Jiritano F, et al. Late Surgical Treatment for Transcatheter Aortic Valve Prosthesis Dysfunction. Ann Thorac Surg 2021;111:e271-3. [Crossref] [PubMed]
17. Fukuhara S, Nguyen CTN, Yang B, et al. Surgical Explantation of Transcatheter Aortic Bioprostheses: Balloon vs Self-Expandable Devices. Ann Thorac Surg 2022;113:138-45. [Crossref] [PubMed]
18. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372: [Crossref] [PubMed]
19. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000;283:2008-12. [Crossref] [PubMed]
20. Kim SY, Park JE, Lee YJ, et al. Testing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validity. J Clin Epidemiol 2013;66:408-14. [Crossref] [PubMed]
21. Zaid S, Kleiman NS, Goel SS, et al. Impact of transcatheter heart valve type on outcomes of surgical explantation after failed transcatheter aortic valve replacement: the EXPLANT-TAVR international registry. EuroIntervention 2024;20:e146-e157. [Crossref] [PubMed]
22. Grubb KJ, Lisko JC, O'Hair D, et al. Reinterventions After CoreValve/Evolut Transcatheter or Surgical Aortic Valve Replacement for Treatment of Severe Aortic Stenosis. JACC Cardiovasc Interv 2024;17:1007-16. [Crossref] [PubMed]
23. Bowdish ME, Habib RH, Kaneko T, et al. Cardiac Surgery After Transcatheter Aortic Valve Replacement: Trends and Outcomes. Ann Thorac Surg 2024;118:155-62. [Crossref] [PubMed]
24. Zaid S, Hirji SA, Bapat VN, et al. Surgical Explantation of Failed Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2023;116:933-42. [Crossref] [PubMed]
25. Tang GHL, Zaid S, Kleiman NS, et al. Explant vs Redo-TAVR After Transcatheter Valve Failure: Mid-Term Outcomes From the EXPLANTORREDO-TAVR International Registry. JACC Cardiovasc Interv 2023;16:927-41. [Crossref] [PubMed]
26. Rösch RM, Brendel L, Buschmann K, et al. Surgery for Infective Endocarditis after Primary Transcatheter Aortic-Valve Replacement-A Retrospective Single-Center Analysis. J Clin Med 2023;12:5177. [Crossref] [PubMed]
27. Hawkins RB, Deeb GM, Sukul D, et al. Redo Surgical Aortic Valve Replacement After Prior Transcatheter Versus Surgical Aortic Valve Replacement. JACC Cardiovasc Interv 2023;16:942-53. [Crossref] [PubMed]
28. Fukuhara S, Wu X, Hawkins R, et al. Prosthetic Valve Endocarditis After Transcatheter and Surgical Aortic Valve Replacement. Ann Thorac Surg 2023;116:314-21. [Crossref] [PubMed]
29. Fukuhara S, Nguyen CTN, Kim KM, et al. Aortic valve reintervention after transcatheter aortic valve replacement. J Thorac Cardiovasc Surg 2023;165:1321-1332.e4. [Crossref] [PubMed]
30. Fukuhara S, Tanaka D, Brescia AA, et al. Aortic valve reintervention in patients with failing transcatheter aortic bioprostheses: A statewide experience. J Thorac Cardiovasc Surg 2023;165:2011-2020.e5. [Crossref] [PubMed]
31. Fukuhara S, Kim KM, Yang B, et al. Reoperation following transcatheter aortic valve replacement: Insights from 10 years' experience. J Thorac Cardiovasc Surg 2024;168:488-497.e3. [Crossref] [PubMed]
32. Fukuhara S, Nguyen CTN, Yang B, et al. Cardiac Reoperations in Patients With Transcatheter Aortic Bioprosthesis. Ann Thorac Surg 2023;116:69-76. [Crossref] [PubMed]
33. Vitanova K, Zaid S, Tang GHL, et al. Aortic valve versus root surgery after failed transcatheter aortic valve replacement. J Thorac Cardiovasc Surg 2023;166:1418-1430.e4. [Crossref] [PubMed]
34. Ogami T, Ridgley J, Serna-Gallegos D, et al. Outcomes of Surgical Aortic Valve Replacement After Transcatheter Aortic Valve Implantation. Am J Cardiol 2022;182:63-8. [Crossref] [PubMed]
35. Yun JJ, Saleh OA, Chung JW, et al. Cardiac Operations After Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2022;114:52-9. [Crossref] [PubMed]
36. Muensterer A, Puluca N, Ruge H, et al. Surgical explantation of failed transcatheter heart valves: indications and results. Heart Vessels 2022;37:2083-92. [Crossref] [PubMed]
37. Guimaron S, Kalavrouziotis D, Maranda-Robitaille M, et al. Macroscopic and microscopic features of surgically explanted transcatheter aortic valve prostheses. J Card Surg 2022;37:3178-87. [Crossref] [PubMed]
38. Ando T, Adegbala O, Aggarwal A, et al. Redo aortic valve intervention after transcatheter aortic valve replacement: Analysis of the nationwide readmission database. Int J Cardiol 2021;325:115-20. [Crossref] [PubMed]
39. Regueiro A, Linke A, Latib A, et al. Infective Endocarditis Following Transcatheter Aortic Valve Replacement: Comparison of Balloon- Versus Self-Expandable Valves. Circ Cardiovasc Interv 2019;12:e007938. [Crossref] [PubMed]
40. Cremer PC, Rodriguez LL, Griffin BP, et al. Early Bioprosthetic Valve Failure: Mechanistic Insights via Correlation between Echocardiographic and Operative Findings. J Am Soc Echocardiogr 2015;28:1131-48. [Crossref] [PubMed]
41. Girard SE, Miller FA Jr, Orszulak TA, et al. Reoperation for prosthetic aortic valve obstruction in the era of echocardiography: trends in diagnostic testing and comparison with surgical findings. J Am Coll Cardiol 2001;37:579-84. [Crossref] [PubMed]
42. Butany J, Feng T, Luk A, et al. Modes of failure in explanted mitroflow pericardial valves. Ann Thorac Surg 2011;92:1621-7. [Crossref] [PubMed]
43. Nair V, Law KB, Li AY, et al. Characterizing the inflammatory reaction in explanted Medtronic Freestyle stentless porcine aortic bioprosthesis over a 6-year period. Cardiovasc Pathol 2012;21:158-68. [Crossref] [PubMed]
44. Sá MP, Jacquemyn X, Van den Eynde J, et al. Impact of Prosthesis-Patient Mismatch After Surgical Aortic Valve Replacement: Systematic Review and Meta-Analysis of Reconstructed Time-to-Event Data of 122 989 Patients With 592 952 Patient-Years. J Am Heart Assoc 2024;13:e033176. [Crossref] [PubMed]
45. Akins CW, Miller DC, Turina MI, et al. Guidelines for reporting mortality and morbidity after cardiac valve interventions. J Thorac Cardiovasc Surg 2008;135:732-8. [Crossref] [PubMed]
46. Sá MP, Jacquemyn X, Van den Eynde J, et al. Impact of Paravalvular Leak on Outcomes After Transcatheter Aortic Valve Implantation: Meta-Analysis of Kaplan-Meier-derived Individual Patient Data. Struct Heart 2023;7:100118. [Crossref] [PubMed]
47. Sá MP, Van den Eynde J, Jacquemyn X, et al. Cusp-overlap versus coplanar view in transcatheter aortic valve implantation with self-expandable valves: A meta-analysis of comparative studies. Catheter Cardiovasc Interv 2023;101:639-50. [Crossref] [PubMed]
48. Sá MP, Van den Eynde J, Jacquemyn X, et al. Computed tomography-derived membranous septum length as predictor of conduction abnormalities and permanent pacemaker implantation after TAVI: A meta-analysis of observational studies. Catheter Cardiovasc Interv 2023;101:1203-13. [Crossref] [PubMed]
49. Faroux L, Guimaraes L, Wintzer-Wehekind J, et al. Coronary Artery Disease and Transcatheter Aortic Valve Replacement: JACC State-of-the-Art Review. J Am Coll Cardiol 2019;74:362-72. [Crossref] [PubMed]
50. Khan F, Okuno T, Malebranche D, et al. Transcatheter Aortic Valve Replacement in Patients With Multivalvular Heart Disease. JACC Cardiovasc Interv 2020;13:1503-14. [Crossref] [PubMed]
51. Sá MP, Ramlawi B, Sicouri S, et al. Lifetime management of aortic valve disease: Aligning surgical and transcatheter armamentarium to set the tone for the present and the future. J Card Surg 2022;37:205-13. [Crossref] [PubMed]
52. Raschpichler M, de Waha S, Holzhey D, et al. Valve-in-Valve Transcatheter Aortic Valve Replacement Versus Redo Surgical Aortic Valve Replacement for Failed Surgical Aortic Bioprostheses: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2022;11:e7965. [Crossref] [PubMed]
53. Sá MPBO, Van den Eynde J, Simonato M, et al. Valve-in-Valve Transcatheter Aortic Valve Replacement Versus Redo Surgical Aortic Valve Replacement: An Updated Meta-Analysis. JACC Cardiovasc Interv 2021;14:211-20. [Crossref] [PubMed]
54. The Society of Thoracic Surgeons Launches New Valve Surgery Risk Calculators. Available online: https://www.sts.org/press-releases/society-thoracic-surgeons-launches-new-valve-surgery-risk-calculators
55. SAVR After TAVR Risk Calculator. Available online: https://www.sts.org/resources/savr-after-tavr-risk-calculator