Surgical Aortic Valve Replacement Following Transcatheter Aortic Valve Implantation Degeneration in a Patient with Prior David Procedure: A Case Report

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Aortic valve insufficiency following TAVI degeneration in a patient with a prior David procedure (n=1). Intervention: Surgical TAVI explantation and redo surgical aortic valve replacement. Primary outcome: Procedural success and postoperative recovery.

Theodor Terra Mayer Tibeau; Tulio M. M. Caldonazo; Rodrigo Petersen Saadi; Angelique Runkel; Sultonbek Toshmatov; Murat Mukharyamov; Hristo Kirov; Torsten Doenst

doi:10.1055/a-2938-6221

January 1, 2026The Thoracic and Cardiovascular Surgeon ReportsOpen Access

Surgical Aortic Valve Replacement Following Transcatheter Aortic Valve Implantation Degeneration in a Patient with Prior David Procedure: A Case Report

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Key result

Redo SAVR with TAV explantation proves feasible after prior valve-sparing aortic root replacement.

n=1

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Why the study?

Challenges in lifetime management of patients with prior David procedure undergoing TAVI include uncertainties about valve durability, sizing, and reoperative strategies.

Key Points

To describe the surgical explantation of a degenerated self-expanding transcatheter aortic valve and subsequent surgical bioprosthesis replacement in a patient with a prior David procedure.
Evaluated a 75-year-old male presenting with dyspnea, severe aortic insufficiency, and paravalvular leakage six years after a valve-in-repaired-valve TAVI with a 34-mm CoreValve Evolut R.
Performed an elective redo median sternotomy using cardiopulmonary bypass, 1,900 mL of Bretschneider cardioplegia solution, and 58 minutes of aortic cross-clamp time.
Explanted the transcatheter valve from the Dacron prosthesis, debrided annular calcifications, and implanted a 23-mm Abbott Epic Max bioprosthesis.
The self-expanding prosthesis was completely explanted from the ascending aorta Dacron graft without arterial injury, achieving good bioprosthetic seating without paravalvular leak.
Postoperative recovery was complicated by ventricular fibrillation, acute kidney injury requiring hemodialysis, and thrombocytopenia with a platelet nadir of 27 Gpt/L.
Following fluid management, evacuation of 2,800 mL of pleural fluid, and clinical stabilization, the patient was discharged to outpatient follow-up on postoperative day 22.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

A 75-year-old man with a prior David procedure and degenerated TAVI who underwent surgical TAVI explantation and redo surgical aortic valve replacement.

I

Intervention

Redo surgical aortic valve replacement (SAVR) via median sternotomy, involving explantation of the degenerated TAVI and implantation of a 23-mm Abbott Epic Max surgical bioprosthesis.

O

Outcome

Procedural success and clinical recovery.

Redo surgical aortic valve replacement with TAVI explantation is feasible in patients with a prior David procedure, as the synthetic Dacron graft may facilitate safer device extraction.

Implication

Provides viable surgical option for failed TAVI after valve-sparing root replacement in select elderly patients; leaves open generalizability and safety data.

Abstract

This is the first reported case of a self-expanding aortic valve explanted from the ascending aorta consisting of a Dacron prosthesis. We describe a 75-year-old male with bicuspid aortic valve regurgitation initially treated with a David procedure. Following degeneration, a "valve-in-repaired-valve" transcatheter aortic valve implantation (TAVI) was performed. Six years later, he presented with dyspnea, severe insufficiency, and paravalvular leakage. An interdisciplinary team opted for redo surgery. The patient underwent successful redo aortic valve replacement with an EpicMax bioprosthesis via resternotomy. Despite a complex postoperative course, he recovered well. This case underscores key challenges in lifetime management, including TAVI durability, sizing, and reoperative strategies.

Discussion

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Cite This Study

Tibeau et al. (2026) conducted a case report in Aortic valve insufficiency following TAVI degeneration in a patient with a prior David procedure (n=1). Surgical TAVI explantation and redo surgical aortic valve replacement was evaluated on Procedural success and postoperative recovery. Surgical explantation of a failed transcatheter aortic valve and redo surgical aortic valve replacement was feasible and successful in an elderly patient with a prior valve-sparing aortic root replacement.

synapsesocial.com/papers/6ad0fce415427f6a84040382 https://doi.org/10.1055/a-2938-6221

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Surgical Aortic Valve Replacement Following Transcatheter Aortic Valve Implantation Degeneration in a Patient with Prior David Procedure: A Case Report

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Surgical Aortic Valve Replacement Following Transcatheter Aortic Valve Implantation Degeneration in a Patient with Prior David Procedure: A Case Report

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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