TAVR and SAVR Removal With Left Ventricular Outflow Reconstruction

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. 

This case involved a patient who had undergone two previous surgical aortic valve replacements and then underwent a third procedure—the placement of a transcatheter aortic valve replacement (TAVR) into the 10-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 Dr. Gaudiani’s surgical team for redo surgical aortic valve replacement after the removal of both the valve-in-valve TAVR and the previous surgical aortic valve.  

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

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