Easy surgical explantation technique for self-expanding transcatheter aortic valve: ‘lasso technique’

Abstract

A prosthesis with a self-expanding nitinol frame firmly incorporates into the aortic wall and thus is difficult to explant. We introduce a novel technique that simplifies explantation.

Easy surgical explantation technique for sutureless Perceval S prosthesis, ‘lasso technique’: a case report

“…Dissection was then carried out using the tourniquet as a handle to control the prosthesis (Additional file 1 : Video 1). Previously [ 3 ], we used two tourniquets to explant a transcatheter aortic valve prosthesis but in the present case, only one tourniquet was sufficient. Adhesions were more severe at the annulus than aortic wall.…”

“…Unlike conventional bioprosthetic aortic valves, sutureless prostheses have self-expanding properties and are incorporated into the aortic wall, annulus, and left ventricular outflow tract, and caution is needed during explantation. The self-expanding property of the sutureless prosthesis is similar to that of the transcatheter aortic valve replacement (TAVR) prosthesis, and there have been several reports on explantation of TAVR prosthesis [ 3 , 4 ]. While TAVR is performed without excision of the calcified aortic valve and annulus, sutureless AVR is performed after excision, and the self-expanding stent is more severely incorporated into the surrounding tissue.…”

“…We used the ‘lasso technique’ to create a dissection plane between the self-expanding prosthesis and intima, as we previously reported [ 3 ]. As shown by the successful outcomes of this case, we believe that the ‘lasso technique’ is still useful for explanting sutureless prostheses.…”

“…We used the ‘lasso technique’ to create a secure dissection plane between the intima and the sutureless aortic prosthesis, which has a self-expanding stent incorporated into the aortic wall. The procedure details were described in our previous report [ 3 ]. In summary, a 2–0 polyester purse-string suture was passed along the edge of the frame and secured using a tourniquet to collapse the prosthesis, creating a secure dissection plane.…”

Left Coronary Ostial Obstruction by a Dislocated Sutureless Aortic Valve Prosthesis: Redo Aortic Valve Replacement with Hybrid Coronary Revascularization: A Case Report

“…2 ). The neointimal fibrous tissue was carefully peeled off, and the prosthesis was removed using the lasso technique [ 1 ]. LM endarterectomy was performed carefully, and cardioplegia was infused through the right coronary ostium to confirm patency.…”