Why the study?
Rising TAVR use has led to increased device failures requiring surgery, but data on surgical explantation after TAVR remain limited.
This case highlights the rare but severe complication of structural valve deterioration and thrombosis post-TAVR that may necessitate complex surgical explantation.
Surgical explantation resolved recurrent AS with embolic risk post-TAVR; leaves open optimal timing and selection criteria.
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is a common treatment for aortic stenosis (AS). Although it is generally safe, its rising use has led to increased device failures and complications requiring surgery. Data on surgical explantation after TAVR remain limited. CASE PRESENTATION: An 85-year-old woman, 1-year post-TAVR, developed recurrent AS. Imaging revealed a mobile transvalvular mass and subvalvular pannus. Medical therapy failed, and because of stroke risk, she underwent TAVR explantation, subannular pannus resection, left ventricular outflow tract repair, and surgical aortic valve replacement. Histology confirmed leaflet thrombosis and valve deterioration. DISCUSSION: Surgical explantation after TAVR occurs in about 1% of cases. Among these, 47% require surgical aortic valve replacement, and 53% need additional procedures, often involving the aorta. Recognizing structural valve deterioration and its cause is critical. TAKE-HOME MESSAGE: As TAVR use rises, so will complications. Further research is needed to enhance management and outcomes.
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Jabagi et al. (2025) studied this question.
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