Surgical explantation of quaternate transcatheter aortic valve replacement bioprostheses: a case report

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is a growing less invasive surrogate for high-risk patients with aortic valve disease. Although the number of TAVR procedures is growing rapidly, TAVR prosthesis surgical explantation are rare procedures but increasing in frequency. CASE PRESENTATION: We herein presented a case of 68-year-old male who underwent quaternate TAVR bioprostheses implantation. Three months later, his symptoms deteriorated due to aggravated paravalvular leakage and severe mitral regurgitation. A challenging surgical explantation procedure was therefore performed. During the surgery, lethal penetrations of aortic wall due to migration of these devices were found and four bioprostheses were integrally explanted. The native calcified aortic leaflet was removed and replaced with a 23 mm. The impaired segment of ascending aorta was replaced with a Dacron graft afterwards. CONCLUSIONS: In summary, we presented a surgical case of explantation of four TAVR Bioprostheses, which is so far the maximum number of surgical-explant devices ever reported. This extreme individual case aggregates our technical experiences with this unique category of patients and raise the concern of the best initial valve strategy for relatively younger patients with severe aortic valve stenosis.