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Early TAVR Explantation Due to a Large Mobile Leaflet Mass and Severe Prosthetic Valve Stenosis
Habib Jabagi1, Victor S Alemany2, Ella Jones2
1Division of Cardiothoracic Surgery, The Valley Hospital, Ridgewood, New Jersey, USA; Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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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