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<p>With the rapid evolution of transcatheter aortic valve replacement (TAVR), the demand for valve reinterventions has also increased accordingly. Surgical explantation of TAVR prostheses has emerged as one of the fastest growing cardiac surgical procedures in modern practice. This review article provides a&#xa0;practical overview of the indications for explant TAVR, differentiates between the clinical scenarios requiring either redo TAVR or cardiac surgery explant TAVR and also systematically presents the surgical techniques. Typical indications for revision (structural valve degeneration, prosthetic valve endocarditis, paravalvular leak and valve insufficiency) are analyzed and tailored approaches for self-expanding versus balloon-expandable valves are compared. The article further addresses the preoperative diagnostics and possible access strategies and discusses concomitant surgical procedures, which are necessary in approximately 60% of cases. Despite surgical refinements, the perioperative mortality for explant TAVR remains high (13–33%), whereby current risk prediction scores systematically underestimate the actual risk. The review concludes with an appraisal of short-term clinical outcomes and the need for robust long-term data.</p>

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Chirurgische Transkatheter-Aortenklappenexplantation

  • 期刊论文

  • 发表日期：

    2025年9月4日

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  • Maximilian Vondran,
  • Marc Irqsusi,
  • Myriam Johanna Schafigh-Tacke,
  • Tamer Ghazy,
  • Ardawan J. Rastan

摘要

With the rapid evolution of transcatheter aortic valve replacement (TAVR), the demand for valve reinterventions has also increased accordingly. Surgical explantation of TAVR prostheses has emerged as one of the fastest growing cardiac surgical procedures in modern practice. This review article provides a practical overview of the indications for explant TAVR, differentiates between the clinical scenarios requiring either redo TAVR or cardiac surgery explant TAVR and also systematically presents the surgical techniques. Typical indications for revision (structural valve degeneration, prosthetic valve endocarditis, paravalvular leak and valve insufficiency) are analyzed and tailored approaches for self-expanding versus balloon-expandable valves are compared. The article further addresses the preoperative diagnostics and possible access strategies and discusses concomitant surgical procedures, which are necessary in approximately 60% of cases. Despite surgical refinements, the perioperative mortality for explant TAVR remains high (13–33%), whereby current risk prediction scores systematically underestimate the actual risk. The review concludes with an appraisal of short-term clinical outcomes and the need for robust long-term data.