Transcatheter Aortic Valve Explant Experience From a High-Volume Structural Heart Center

When transcatheter aortic valve replacement (TAVR) fails and repeat TAVR is not possible, TAVR explantation remains a viable strategy. However, results from multicenter studies have shown high morbidity and mortality. This study aimed to examine early and late outcomes after TAVR explantation at a high-volume structural heart center.

At a single center performing >600 TAVR procedures annually, the institutional The Society of Thoracic Surgeons registry was queried to identify all patients undergoing surgical aortic valve replacement with a history of TAVR between 2011 and 2024. Institutional trends, operative details, and outcomes at 30-days and 5-years were compared between TAVR explantation with isolated surgical aortic valve replacement (SAVR; n = 14) and TAVR explantation with SAVR plus concomitant procedures (n = 40).

TAVR implantations and explantations increased significantly over time (P < .001). The median time to TAVR explantation was 455 days (interquartile range, 145-1094 days), and the median surgeon TAVR explantation experience was 4 cases (interquartile range, 1-11 cases). Overall, 30-day mortality (7.4%) and 30-day morbidity and mortality (25.9%) were relatively low despite high rates of concomitant procedures (74.1%). There were no differences in 30-day mortality (P = .52) or 5-year survival (hazard ratio, 1.78; 95% CI, 0.38-8.40; P = .47) between the isolated SAVR and concomitant procedures groups.

The risk of morbidity and mortality was relatively low in patients undergoing TAVR explantation in a single high-volume center, a finding highlighting the potential need to centralize care for this complex procedure.