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Outcomes of Surgical Aortic Valve Replacement after Transcatheter Aortic Valve Replacement
Takuya Ogami1, Jacqueline Ridgley2, Derek Serna-Gallegos1, Dustin Kliner1, Catalin Toma1, Saurabh Sanon1, James Brown1, Sarah Yousef1, Ibrahim Sultan1.
1University of Pittsburgh Medical Center, PITTSBURGH, PA, USA, 2University of Pittsburgh, PITTSBURGH, PA, USA.

OBJECTIVE: While transcatheter aortic valve replacement (TAVR) has been widely accepted, several complications necessitate surgical aortic valve replacement (SAVR) after TAVR. However, a few institutions have reported their experience in explantation of transcatheter heart valve. Lack of evidence requires further examination of these entities.
METHODS: Our single institutional database was retrospectively reviewed to identify patients who underwent surgical aortic valve replacement following transcatheter aortic valve replacement. The baseline characteristics and outcomes were described.
RESULTS: We found 2,100 patients who underwent TAVR from 2013 through 2021. Of 2,100, 17 patients underwent SAVR after TAVR including surgical bailout. The mean age was 78.3 years old. Comorbidities were very frequent including coronary artery disease (70.6%), atrial fibrillation (52.9%), cerebrovascular disease (47.1%), and pulmonary hypertension (41.2%). A history of prior cardiac surgery was observed in 6 (35.3%). The mean predicted risk of mortality at the time of TAVR was 7.7%. Surgical bailout was the most common indication of valve explantation (n=8, 47.1%), followed by infectious endocarditis (n=4, 23.5%), and paravalvular leak (n=2, 11.8%). The valve-in-valve TAVR was not feasible due to endocarditis, paravalvular leak, history of valve-in-valve TAVR. Overall, 13 (76.5%) were performed urgently or emergently, and 10 (58.9%) required aortic root reconstruction. The mean cardiopulmonary bypass time was 158.5 minutes. In-hospital mortality was 41.2%.
CONCLUSIONS: Transcatheter heart valve explantation continues to be rare, however, these data will continue to be informative as TAVR explantations will become more common with time.


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