Key result
The SURPLUS procedure (surgical resection of prosthetic valve leaflets with hybrid TAV-in-TAV placement) was utilized as a solution for a high-risk patient with complex bioprosthetic valve failure.
Why the study?
Solutions for high-risk patients with prior TAVR remain challenging, and TAV-in-TAV may not be feasible due to the risk of coronary occlusion.
Case Report (n=1)
The SURPLUS procedure offers a potential hybrid surgical and transcatheter solution for high-risk patients with complex aortic root anatomy and prior TAVR where standard TAV-in-TAV is not feasible due to coronary occlusion risk.
Valve-in-valve transcatheter aortic valve (TAV) replacement (TAVR) is becoming increasingly more common in patients with bioprosthetic valve failure. However, solutions for high-risk patients with prior TAVR deployment remain challenging, and TAV-in-TAV may not be feasible because of the risk for coronary occlusion. We revisit the SURPLUS procedure, surgical resection of prosthetic valve leaflets under direct vision, with hybrid placement of a TAV-in-TAV for a patient who had prior valve-in-valve TAVR complicated by left main coronary artery occlusion warranting emergent left main snorkel placement, now with moderate to severe aortic insufficiency complicated by heart failure.
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Murfee et al. (2025) conducted a case report in Bioprosthetic valve failure with moderate to severe aortic insufficiency and heart failure (n=1). SURPLUS procedure (surgical resection of prosthetic valve leaflets under direct vision, with hybrid placement of a TAV-in-TAV) was evaluated. The SURPLUS procedure (surgical resection of prosthetic valve leaflets with hybrid TAV-in-TAV placement) was utilized as a solution for a high-risk patient with complex bioprosthetic valve failure.
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