Key result
TAVR explantation and SAVR with aortic root enlargement triggers complete heart block requiring a pacemaker.
Case Report (n=1)
TAVR explantation with SAVR and aortic root enlargement is a feasible approach for failed TAVR in patients with small annuli at high risk for coronary occlusion, though it carries risks of conduction abnormalities and aortic injury.
Risk of complete heart block after TAVR explantation with root enlargement warrants caution; leaves open need for larger studies on procedural safety.
A 73-year-old woman with history of severe aortic stenosis who underwent transcatheter aortic valve replacement (TAVR) with a size 23 self-expandable valve 5 years ago presented with symptomatic severe bioprosthetic aortic stenosis. Given the small aortic annulus and high risk for coronary occlusion in a valve-in-valve procedure, she underwent TAVR explantation, surgical aortic valve replacement with aortic root enlargement to put in a size 23 surgical bioprosthetic aortic valve, and ascending aorta replacement due to the injury of intima in the ascending aorta. Her recovery was complicated by complete heart block. She required permanent pacemaker placement on postoperative day 1 and was discharged home on postoperative day 7.
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Liu et al. (2025) conducted a case report in symptomatic severe bioprosthetic aortic stenosis (n=1). TAVR explantation, surgical aortic valve replacement with aortic root enlargement, and ascending aorta replacement was evaluated. TAVR explantation and surgical aortic valve replacement with aortic root enlargement in a 73-year-old woman was complicated by complete heart block requiring a pacemaker on postoperative day 1.
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