Excision of a Six-Year-Old Evolut CoreValve TAVR 

This article is part of CTSNet’s series, Perfecting TAVR Removal | Skills Sharpening With Vince Gaudiani. CTSNet Senior Editor Dr. Vince Gaudiani presents nine surgical videos on the technical aspects of aortic valve replacement after TAVR. This series will conclude in three live learning roundtable events scheduled at three different times to accommodate participants in multiple regions of the world. 

The patient, who was in his 70s and diagnosed with advanced lung cancer, had an Evolut transcatheter aortic valve replacement (TAVR) placed in 2019. Immunotherapy had been controlling his cancer very well; however, the valve had failed. An upper ministernotomy was performed, and the aorta was opened.  

The Evolut valve was found to be stuck to the intima of the aorta, and Weschler scissors were used to peel the CoreValve away, leaving the aortic wall intact. The aim was to reduce the radius of the valve to allow its removal, with the removal starting in an area of the aorta that could be easily patched. 

The handlebar moustache technique was used to remove the valve. Because it was significantly stuck, a third of the valve was cut out to allow for more instruments to be used during excision. The full removal is shown without editing to depict every step.  

Once removed, a 27 mm Mosaic biological aortic valve was placed after fully debriding the annulus, and the aorta was closed.   

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