TAVR Explant with Aortic Root Replacement Using a Homograft for an Aortic Rupture
Saket Singh, Roland Assi.
Yale University School of Medicine, New Haven, CT, USA.
Background: Prosthetic valve endocarditis (PVE) is responsible for 10-30% of cases of the total burden of infective endocarditis (IE) and is associated with a greater than four-fold increase in overall mortality. PVE involving TAVR (TAVR-IE) is a particularly tragic complication related to increased aortic abscess and fistula formation. As a result, TAVR-IE carries higher in-hospital mortality of 20.9%. Aortic rupture is a rare and catastrophic event following TAVR. Methods: Herein, we describe the surgical management of a 69-year-old male who presented with aortic rupture in the setting of TAVR-IE. The patient required aortic root replacement with a homograft mandated by the size of the aortic tear and severe degeneration of the aortic root. Results and Conclusions: The juxtaposition of the TAVR prosthesis with the ascending aorta, sinuses of Valsalva, left ventricular outflow and mitral apparatus at times makes the explantation of the TAVR prosthesis extremely tedious, especially with a Self Expanding TAVR prosthesis, given its longer frame and self-expanding nature. This video case report describes the explantation of a TAVR valve and various technical challenges faced by the surgeon given advanced degeneration of the aortic sinuses post TAVR implantation, which was compounded by the aortic tear in the setting of an infected prosthesis.
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