TAV-in-TAV Explant Through Surgical Resection of Prosthetic Valve Leaflets Under Direct Vision: SURPLUS.

Transcatheter aortic valve replacement (TAVR) has become a widely utilized procedure for treating aortic stenosis (AS). However, TAVR-related complications are rising, with TAVR explants becoming the fastest growing cardiac surgery procedure. We report a case of an 80-year-old female with severe AS status post TAVR and subsequent TAV-in-TAV a few years later. She was found to have severe stenosis of her more recent TAV and was scheduled for surgical TAVR explant. The inner, most recent TAV was completely removed, and only the leaflets of the outer, older TAV were resected, sparing the stent frame. This was followed by deployment of a new TAV within the preserved frame under direct visualization. The patient's postoperative recovery was uncomplicated, and 1-month follow-up was reassuring. We highlight the advantages of this approach in minimizing aortic manipulation, reducing the risk of aortic wall damage, and potentially optimizing overall outcomes in a high-risk procedure.