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Recapturing Technique for TAVR Explant—A Safe Operative Method
Nasir Chatha H, Papus M, Rafael Baeza C. Recapturing Technique for TAVR Explant—A Safe Operative Method. June 2025. doi:10.25373/ctsnet.29274713
Explantation of transcatheter aortic valve replacement (TAVR) prostheses is currently the fastest-growing operation in cardiac surgery. To date, the quoted morbidity and mortality rates are unacceptably high. Therefore, safe operative options are mandatory. The challenge is generally due to the extensive tissue ingrowth and fibrosis. In this video, the authors describe a novel chest tube snaring technique that facilitates TAVR explant in a safe and controlled manner without causing damage to the adjacent structures.
A patient who presented with worsening shortness of breath underwent a standard investigative workup including a transthoracic echocardiogram (TTE), which demonstrated a significant paravalvular leak. In the operating room, she underwent a median sternotomy and was placed on cardiopulmonary bypass. After achieving electrical and mechanical silence of the heart, an aortotomy was performed to fully exposed the TAVR valve. A 1-0 polydioxanone suture (PDS) was woven through the crown of the valve, and both limbs were passed through a 32-French chest tube, which served as a tourniquet to progressively snare and collapse the valve inward inside the tube. Ice slush was applied to soften the valve frame to aid in the recapturing process. The native aortic valve leaflets and coronary sinuses were not damaged. This technique allowed for en bloc removal of the TAVR valve with minimal manipulation or trauma to the aortic root apparatus. Subsequently, the native aortic leaflets were excised, and the aortic valve was replaced with a rapid deployment valve. Overall, the chest tube snaring method proved to be a simple, reproducible, and safe method for TAVR explantation.
References
- Tully A, Lee ACH, Gruessner S, Massad M, Abdelhady K. Surgical Transcatheter Aortic Valve Replacement Explantation Technique. Ann Thorac Surg. 2022 Dec;114(6):e471-e473. doi: 10.1016/j.athoracsur.2022.03.015. Epub 2022 Mar 25. PMID: 35346627.
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