Surgical Removal Of TAVR Valves
J. James Edelman, MBBS(Hons) PhD, Christian Shults, MD, Lowell Satler, MD, Vinod Thourani, MD.
MedStar Washington Hospital Center, Washington, DC, USA.
OBJECTIVE: The number of transcatheter aortic valve replacement (TAVR) implanted now outnumbers the number of surgical aortic valves implanted on an annual basis. The incidence of surgical explant of TAVR valves is not known. The objective of this video is to share techniques for surgical removal of self- and balloon-expandable TAVR valves.
METHODS: Surgical techniques are shown in the video.
RESULTS: A self-expanding valve was removed 2 years after implant for endocarditis and aortic pseudoaneurysm in an 82 year old patient. A balloon-expandable valve was removed 6 months after implant, also for endocarditis, in an 80- year old patient. Both cases were challenging; the properties of each valve puts adjacent structures, namely the aorta, coronary arteries and mitral valve, at risk during valve removal. Both valves were successfully removed and replaced with surgical bioprostheses. Both patients recovered well and were discharged home.
CONCLUSIONS: The incidence of TAVR valve removal will most likely increase. Surgeons need to be prepared for this increase with techniques to remove valves and repair adjacent structures.
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