Robotic-Assisted Transcatheter Aortic Valve Explantation and Aortic Valve Replacement.

PURPOSE: Transcatheter aortic valve replacement (TAVR) in younger patients may be complicated by premature structural valve degeneration. This report describes robotic TAVR explantation and aortic valve replacement.

DESCRIPTION: A 67-year-old woman who underwent low-risk, 23-mm balloon-expandable TAVR 4 years previously presented with severe prosthetic aortic stenosis, a drop in ejection fraction to 35%, severe type III mitral regurgitation, and symptomatic heart failure. She had scoliosis and rheumatoid arthritis, and The Society of Thoracic Surgeons predicted risk of mortality was 7.9%. Given her younger age and need for double valve replacement, transcatheter options were deferred, and she was referred for intermediate- to high-risk nonsternotomy surgical consideration.

EVALUATION: After obtaining informed consent, a right lateral transaxillary working incision facilitated robotic TAVR explantation, followed by 21-mm bioprosthetic aortic valve replacement with concomitant mitral valve replacement. The total cross-clamp time was 195 minutes. The patient recovered expectantly and was discharged home.

CONCLUSIONS

Robotic TAVR explantation and aortic valve replacement are feasible and may represent a viable future option for patients of low to intermediate surgical risk.