Surgical Techniques for Removal and Replacement of Chronically Implanted TAVR Prosthesis: Step by Step

Abstract

Transcatheter aortic valve replacement has substantially grown in volume over the years, and increasingly is being used in patients with longer life expectancy, including younger patients. With increasing implantation of transcatheter heart valves (THV) the need for explantation of these devices with replacement of the aortic valve will also go up. Bioprosthetic valve endocarditis, along with paravalvular leaks and structural valve degeneration will be the leading causes requiring THV explantation and redo-aortic valve replacement (AVR). Given the cascade of trials in different populations and the rapid development cycle for THV, the patients, design and composition of the bioprostheses being explanted will vary considerably. However, many of the preoperative considerations, imaging and technical considerations in patients with a failed THV will be the same. Here, we highlight the technical steps to achieve a safe THV explantation and redo-AVR.