Successful explantation of an EDWARDS INTUITY rapid deployment valve with concomitant annular enlargement

BACKGROUND: Rapid deployment aortic valves, such as the Edwards Intuity valve, shorten implantation times and facilitate less-invasive approaches. The features that enable the valve's rapid deployment pose a technical challenge if explant is required, as in the instance of endocarditis or structural valve deterioration (SVD), because the prosthesis often becomes densely invested in surrounding cardiac structures. Although international reports describe Intuity and Perceval explants, none have been reported from the United States with annular enlargement. CLINICAL PRESENTATION: A 69-year-old woman with a bicuspid aortic valve underwent mini-thoracotomy aortic valve replacement eight years prior with a 23 mm Edwards Intuity valve. Seven years postoperatively she presented with progressive dyspnea and echocardiography showing moderate prosthetic stenosis (valve area 1.3 cm²). After several months of observation, she returned with severe stenosis (mean gradient 60 mmHg, valve area 0.78 cm²). Valve-in-valve transcatheter aortic valve replacement was considered, but surgery was favored given her small valve size and relatively young age. At reoperation, the prosthesis was densely adherent to the aortomitral curtain and left ventricular outflow tract, necessitating transection and careful dissection for safe removal. A Rittenhouse-Manouguian annular enlargement allowed implantation of a 25-mm Edwards Inspiris Resilia valve. She was discharged on postoperative day 5 and follow-up showed excellent recovery in normal sinus rhythm. CONCLUSION: Explantation of the Edwards Intuity rapid deployment valve with Rittenhouse-Manouguian annular enlargement is feasible and safe, offering a surgical option for SVD.