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Related Concept Videos

Mitral Stenosis III: Medical Management01:26

Mitral Stenosis III: Medical Management

Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...

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Transcatheter aortic valve replacement explant various techniques.

Alexander A Brescia1, Puja Kachroo1, Tsuyoshi Kaneko1

  • 1Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.

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|April 24, 2025
PubMed
Summary

Transcatheter aortic valve replacement explantation (TAVR-explant) is a rapidly growing cardiac procedure. Standardized surgical techniques are essential for improving outcomes in this complex operation.

Keywords:
Transcatheter aortic valve replacement (TAVR)aortic stenosisendocarditissurgical aortic valve replacement (SAVR)

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Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Medical Device Technology

Background:

  • Transcatheter aortic valve replacement (TAVR) now constitutes 80% of US aortic valve replacements, leading to an increase in TAVR valves requiring explantation.
  • TAVR explantation (TAVR-explant) is the fastest-growing cardiac procedure, driven by TAVR's use in lower-risk and younger patients.

Discussion:

  • TAVR-explant is associated with higher operative mortality than redo-SAVR and requires meticulous preoperative planning.
  • Key considerations include valve type (self-expanding vs. balloon-expandable), concomitant cardiac surgery, and managing adjacent coronary stents.
  • Standardized technical principles are crucial for cardiac surgeons to manage this increasingly common procedure.

Key Insights:

  • TAVR-explant procedures are rising due to TAVR expansion and various failure modes.
  • Effective TAVR-explant necessitates comprehensive imaging and tailored surgical strategies.
  • Addressing specific challenges like adjacent stents and concomitant valve disease is vital.

Outlook:

  • The increasing volume of TAVR-explant procedures demands a broader understanding of surgical techniques among cardiac surgeons.
  • Developing and disseminating standardized approaches will be critical for optimizing patient outcomes.
  • Further research into optimizing TAVR-explant techniques and reducing associated mortality is warranted.