Work

Surgical explantation following early transcatheter aortic valve failure: Technical considerations for complex situations

Year: 2026

Type: article

Abstract: Video clip is available online.TAVR, transcatheter aortic valve replacement; IRB, institutional review board; LIMA-LAD, left internal mammary artery to left anterior descending; BEV, balloon-expandable valve; SEV, self-expanding valve.As indications for transcatheter aortic valve replacement (TAVR) expand, the incidence of TAVR failure and complexity of affected patients will continue to increase, compounding already high operative risks. 1 We present two cases of early TAVR failure following prior sternotomy, representative of the complexity that surgeons will be expected to encounter and manage (Video 1).The Emory University institutional review board (IRB) approved the study protocol and the publication of data (IRB00022795; approved August 3, 2009).Written patient consent was waived by the IRB for publication of deidentified, HIPAAcompliant patient data.Case 1 describes a patient with a patent left internal mammary artery to left anterior descending (LIMA-LAD) graft and early failure of a balloonexpandable valve (BEV) after 21 months (Figure 1).The video depicts considerations for managing LIMA-LAD flow to optimize valve exposure, a double-Kocher technique 2 for valve removal, and particular considerations for BEVs.Case 2 describes a patient presenting with a stroke 27 months after valve-in-valve TAVR, secondary to severe sinus of Valsalva thrombosis 3 (Figure 2).The video depicts sharp VIDEO 1.A demonstration of TAVR explant techniques.Case 1 involves management of a patent LIMA-LAD, followed by double-Kocher technique for BEV explant.Case 2 involves extensive sinus of Valsalva thrombosis and root destruction.A tourniquet technique was used, and a root replacement was required.

Source: JTCVS structural and endovascular.

DOI: 10.1016/j.xjse.2026.100149

Authors: R. Michael Reul, Alexander P. Nissen, Bradley G. Leshnower

Institutions: Emory Healthcare, MedStar Washington Hospital Center

Language: English

Topic: Cardiac Valve Diseases and Treatments

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,500