EARLY EXPERIENCE IN THE EXPLANTATION OF PERCUTANEOUS AORTIC VALVES DUE TO ENDOCARDITIS OR VALVE DEGENERATION

Background: The rise in transcatheter aortic valve implantation (TAVI) has increased the need for surgical removal of degenerated or infected TAVI valves. However, reports on TAVI removal are limited. This study presents our initial experience with surgical explantation of percutaneous aortic valves. Materials and Methods: Between 2017 and March 2024, a total of 8 patients underwent surgical removal of a percutaneous aortic valve at our institution due to either degeneration or endocarditis. The explanted valves included balloon-expandable prosthesis (n=3), self-expandable and mechanically expandable prosthesis (n=5). Results: The patient cohort consisted of 8 males with a mean age of 71.5 years (IQR 63.25–79.0). Half of the patients (4, 50%) were diagnosed with acute endocarditis. Previously implanted TAVI devices included Boston Scientific Acurate Neo (12.5%), Boston Scientific Lotus (50%), Edwards Sapien (25%), and Meril Myval (12.5%). Median preoperative EuroSCORE II was 8.04 (IQR 4.97-10.53). Surgical interventions included isolated aortic valve replacement in 6 patients, a Bentall procedure in 1, and a Commando procedure in 1. One patient had a minimally invasive approach. Median CPB time was 126.5 minutes (IQR 89.0-183.5), and median aortic cross-clamp time was 77.5 minutes (IQR 64.0-146.5). Median ventilation time was 9 hours (IQR 5.75-13.5), and the median ICU stay was 2.5 days (IQR 2-3). No major postoperative complications were observed, and no hospital mortality occurred. Conclusions: This study shows that surgical removal of percutaneous aortic valves is feasible and safe in a high-risk cohort. As TAVI valve issues increase, refining techniques and collecting more data is crucial.