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International Society For Minimally Invasive Cardiothoracic Surgery

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Outcomes Of Surgical Aortic Valve Replacement (savr) After Transcatheter Aortic Valve Replacement (tavr)
Qasim Al abri, Areeba Ali, Moritz Wyler von Ballmoos, Marvin Atkins, Mahesh Ramchandani, Thomas MacGillivray, Michael Michael J. Reardon.
Houston Methodist Hospital, Houston, TX, USA.

BACKGROUND: Like any other biological valve, transcatheter valves are prone to various short- and long-term events that may lead to valve dysfunction. With the increasing number of TAVR implants in younger and low risk patients, we are expecting to see more failing TAVR valves. Although surgical explanation and TAVR in TAVR are the only available options, data on both strategies is still limited. We present a single center experience and outcomes of TAVR valve explanation
METHODS:A total of twenty-two patients who underwent TAVR explanation at our institute were identified. The demographic, surgical, and follow-up data were collected through the STS database and retrospective chart review. Sixteen patients with previous successful TAVR who presented with a delayed TAVR failure for surgical intervention were included in the study. Patients with immediate salvage conversion to SAVR for a failed TAVR implantation were excluded from this analysis (n=6). Ten cases had explant of a single TAVR valve and 6 cases had a previous valve-in-valve
RESULTS:Out of the 16 patients, 69% were males (11/16) with a mean age was 73.1 ± 9.67 years. The average time between TAVR and SAVR was 25 months. Twelve patients presented with prosthetic valve dysfunction, three presented with infective endocarditis, one with type A dissection. Both sutured bioprosthetic valves (n=12) and rapid deployment valves were used (n=4). There were 4 annular enlargements performed but no root replacement was needed.
The average STS score pre-TAVR was 5.6. Pre-explant STS score of 1 patient had low risk, 12 had intermediate and only 3 had a high predicted risk of mortality. The observed 30-day mortality following SAVR was 12.5% (2/16). 6 months mortality was 12.5% (2/16). 12 patients are alive past 1 year. The mean cardiopulmonary bypass and cross-clamp times were 143 mins and 104 mins respectively. Average ICU time was 151 hours. Almost all patients (15/16) required intraoperative blood transfusions. Total average hospital stay was 18 days.
CONCLUSIONS:SAVR after TAVR is a reasonable choice for failed TAVR valves. The increased observed mortality is related to surgical complexity and to progression of patients’ risk status at the time of the explant


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