Citations 2
Early Predictors of Surgical Explantation of Transcatheter Aortic Valve Replacement: A Multi-Center International Database Analysis
Bcharah, George , Kumar, Sant, Farina, Juan M., Bcharah, Hend , Abdelnabi, Mahmoud , Sayegh, Jonathan , Ibrahim, Ramzi, Kandil, Omneya , Nabi, Hussein Abdul , Jabri, Ahmad, Naik, Hursh, Yoon, Pyong D., Barrus, Bryan , Sell‐Dottin, Kristen , Farina, Juan M. , Kumar, Sant , Kumar, Sant J , Farina, Juan M , Abdul Nabi, Hussein , Sell-Dottin, Kristen A , Bcharah, Hend , Ibrahim, Ramzi , Barrus, Bryan
Journal of Clinical Medicine | February 16, 2026 | Volume: 15 | Issue: 4 | Pages: 1527
Background: Indications for TAVR explant have been established, although limited data exist regarding pre-TAVR baseline characteristics that predict eventual explantation. Methods: The TriNetX network, a database comprising medical records from over 105 institutions, was used. Two cohorts were created: those who underwent TAVR without explant and those requiring subsequent TAVR explant and SAVR. Predictors of explantation were analyzed by multivariate models. Results: Among the 63,377 patients undergoing TAVR, 273 (0.4%) required explantation. Patients in the explant group were younger (69.1 ± 11.3 vs. 78.1 ± 8.8 years; p < 0.001), more likely to have a thoracic aortic aneurysm (TAA) (10.6% vs. 4.7%; p < 0.001) and had higher LDL levels (88.2 ± 41.3 vs. 80.7 ± 34.6 mg/dL; p = 0.011). They also had increased post-TAVR rates of acute kidney injury (9.2% vs. 5.2%; p = 0.004) and paravalvular leak (5.9% vs. 0.9%; p < 0.001). Age at TAVR (HR 1.04; CI 1.03–1.06), baseline TAA (HR 1.69; CI 1.09–2.63), history of infective endocarditis (HR 1.92; CI 1.10–3.35), and higher LDL (HR 1.02; 95% CI 1.00–1.03) were independent predictors for explantation. Conclusions: Younger age at TAVR, TAA, history of endocarditis, and elevated baseline LDL were notable predictors of explantation. These findings highlight the necessity of pre-procedural assessment and follow-up in high-risk patients to optimize TAVR durability.
Comparing Early Intervention to Watchful Waiting: A Review on Risk Stratification and Management in Asymptomatic Aortic Stenosis
Khedr, Ahmed E. , Odeh, Nour B., Bcharah, George , Abdalla, Hesham, Senjab, Abdulrahman , Zeineddine, Rawan M. , Ram, Jai, Farina, Juan M. , Crystal, Owen , Barrus, Bryan , Lester, Steven J., Shipman, Justin , Alsidawi, Said , Sell‐Dottin, Kristen , Arsanjani, Reza , Abdalla, Hesham M, Ram, Jaikrishnan, Crystal, Owen R, Sell-Dottin, Kristen A , Arsanjani, Reza , Farina, Juan M , Alsidawi, Said , Khedr, Ahmed , Ram, Jaikrishnan
Medicina | March 4, 2025 | Volume: 61 | Issue: 3 | Pages: 448
Aortic stenosis is a progressive condition with substantial implications for morbidity and mortality. In recent years, attention has shifted toward risk stratification and the development of individualized management plans to optimize treatment outcomes. The management of asymptomatic patients has become a topic of significant controversy, as emerging studies challenge traditional watchful waiting guidelines and propose the potential benefits of early intervention. While early intervention may reduce overall morbidity and mortality in this patient population, the associated procedural risks remain a critical consideration. This review seeks to analyze the existing literature, offering an updated perspective on patient risk stratification and evidence evaluating both management approaches.