Surgical explantation of transcatheter heart valves: A single institution experience

Over the past decade, there has been a dramatic growth in the utilization and diversity of available transcatheter devices for the replacement and repair of all heart valves. The aim of this study is to examine temporal trends, failure profiles, and clinical outcomes involved in the surgical explantation of transcatheter valve prostheses.

Adult patients undergoing surgical explantation of transcatheter valve prostheses between 2014 and 2022 at a single institution were identified. Retrospective cohort review and survival analysis were performed to assess patient characteristics, indications for explant, and operative outcomes.

From 2014 to 2022, 8 surgeons at a single institution performed explantation of transcatheter valve prostheses in 44 patients. Among explanted devices, 50% were removed within 1 year of transcatheter implantation. Surgical explantation was performed on an urgent or emergent basis in 57% of patients. Indications for explantation included valve prosthesis failure (57%), iatrogenic injury (16%), and endocarditis (11%). Operative mortality was 11%, with a mean Society of Thoracic Surgeons mortality risk of 12%. Patients undergoing elective explantation had improved survival compared with those undergoing urgent or emergent explantation (P = .03). Overall survival was 77% at 3 years following transcatheter valve explantation.

There is a rising annual incidence of transcatheter valve explantation in all valve positions. Surgical explantation performed on both elective and non-elective bases is increasingly common in adult cardiac surgical practice. The clinical impact of transcatheter valve explantation is significant and should be strongly considered by multidisciplinary heart teams in the lifetime management strategy of cardiac valvular disease.