Mastering Redo Surgery After TAVR: TAVR Removal, Surgical AVR, and Ascending Aortic Replacement

In this series of videos, Dr. Vincent Gaudiani shares his experience in the new field of surgery after previous TAVR and provides his tips for safely performing redo surgery for a variety of indications including TAVR early and late failure, endocarditis, and when further valve surgery is required.

This video presents the case of a seventy-two-year-old woman who underwent a Sapiens TAVR two and a half years prior. The procedure had initially gone well, but after a year she had an increasingly stenotic valve and the aorta had enlarged. The decision was therefore made to perform an ascending aorta replacement. This was performed using a mini sternotomy with femoral vein cannulation. 

The TAVR was removed with the handlebar mustache technique that is shown in the video and the annulus was debrided and sized for the valve. A 25 mm Edwards Inspiris valve easily fit into the debrided annulus. Then, an ascending aortic tube graft was placed to complete the operation. 

This is the case of a patient who had two previous surgical aortic valve replacements and then underwent a third procedure—the placement of a TAVR into the ten-year-old surgical aortic valve. This TAVR procedure led to a significant patient prosthesis mismatch, which left the patient significantly short of breath. He was referred to this surgical team for redo surgical aortic valve replacement after removal of the valve-in-valve TAVR, and then the previous surgical aortic valve. 

After removing both valves, the team resected the scarred aorta between the left coronary cusp and the noncoronary cusp. They then performed a patch enlargement of the aortic outflow tract before placing a size 27 mm valve. 

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