Surgeons Report Favorable Outcomes for High-Risk TAVR Explant and SAVR Patients
Surgeons Report Favorable Outcomes for High-Risk TAVR Explant and SAVR Patients
Date: May 12, 2025 | Source: The Annals of Thoracic Surgery.
1. Background:
• When a TAVR valve fails, redo TAVR is not always possible. In such cases, surgical explant of the TAVR valve followed by surgical aortic valve replacement (SAVR) is often required—though it carries significant risks.
2. Study Overview (UAB Experience):
• Surgeons at the University of Alabama at Birmingham (UAB) analyzed data from 33 high-risk patients (mean age 75) who underwent TAVR explantation + SAVR.
• These patients were part of a larger group of 2,000+ who had previously undergone TAVR.
• Indications for explant included:
• Bioprosthetic degeneration
• Endocarditis
• Severe paravalvular leak
• Ventricular septal defect
• All patients were ineligible for redo TAVR per heart team evaluation.
3. Procedural Details:
• All surgeries were performed via median sternotomy, with standard bypass, myocardial protection, and explant techniques (e.g., “peel-away” or “roll” method).
• Only bioprosthetic SAVR valves were used.
• No Bentall procedures were needed; root repair was required in 3 cases.
4. Outcomes:
• 30-day survival: 94%
• 1-year survival: 81.4%
• 3-year survival: 61.6%
• Perioperative mortality: 6%
• Average hospital stay: 10 days
• The TAVR explant rate at UAB was 1.3%, in line with published data (0.5–2%).
5. Clinical Implications:
• Despite the high-risk nature of these patients, the team reported some of the best short- and mid-term survival results to date.
• Success was attributed to:
• Careful patient selection and optimization
• Surgical efficiency and simplicity
• Focused postoperative management
• Outcomes were worse when mitral surgery was combined with explant.
6. Conclusion:
• As TAVR volumes rise, surgical teams must adapt to the growing need for explantation procedures.
• Institutional experience and understanding of cohort-specific risk factors are key to improving safety and outcomes.
