TAVR Removal, Surgical AVR, and Ascending Aortic Replacement

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 video presents the case of a 72-year-old woman who underwent a Sapiens transcatheter aortic valve replacement (TAVR) two and a half years prior. The procedure had initially gone well, but after one year, she had an increasingly stenotic valve, and the aorta had enlarged. Therefore, the decision was made to perform an ascending aorta replacement. This was performed using a ministernotomy with femoral vein cannulation.  

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

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