Late Surgical Explantation and Aortic Valve Replacement After Transcatheter Aortic Valve Implantation

Surgical Removal and Replacement of Chronically Implanted Transcatheter Aortic Prostheses: How I Teach It

“…As one would imagine, the relative lack of endothelialization makes extraction of a device in the short term relatively uncomplicated. Later surgical extraction is clearly a different operation [7]. Although removing a Sapien valve is made challenging because of the degree of endothelial ingrowth into the open cell structure, its anatomic location within the annulus makes the surface area that one has to liberate from the heart relatively small.…”

How to Perform a Late Surgical Explantation of a CoreValve Aortic Bioprothesis

“…As transcatheter procedures are performed in younger and lower-risk patients we can expect an epidemic of patients with implanted transcatheter prostheses requiring late surgical removal [2,3]. Surgeons need to know a suitable and safe technique for these cases.…”

“…For the short term, an adequate surgical technique has been already published [1]. However, for the long term, when neoendothelialization and incorporation of the stent in the aortic root have already occurred [2], the surgical technique has not been described. Recently, we successfully removed a CoreValve prosthesis (Medtronic Inc., Minneapolis, MN) that had been implanted 2103 days previously in a 61-year-old patient.…”

The potential emerging truth about balanced sacrifices in surgery

“…Previously published case reports on the CoreValve (Medtronic, Inc, Minneapolis, Minn) prosthesis removal described an easy explantation with proper aortic wall endarterectomy. 5 As a result of the Perceval S prosthesis design, we first thought that the removal would be easily performed. In this case, the prosthesis stent was covered by neoendothelialization and included in the aortic wall.…”