Totally Endoscopic Approach for TAVR Explantation and Subsequent Surgical AVR Using a 3D Endoscope System.

OBJECTIVES

Surgical aortic valve replacement (SAVR) after transcatheter aortic valve replacement (TAVR) has a higher mortality rate than standard SAVR. We present a successful minimally invasive TAVR explantation and SAVR using the lasso technique in conjunction with a 3D endoscope.

KEY STEPS: 1) Aortotomy was performed where the nitinol frame was easily palpable. 2) The first purse-string suture was placed around the edge of the frame. 3) After exposing the widest part of the frame, a second purse-string suture was placed at the same level. 4) The second lasso was used to expose the annulus, ensuring safe explantation.

POTENTIAL PITFALLS: Comprehensive understanding of the prosthesis structure and the surgical dissection plane is essential to prevent aortic injury. Excessive traction can damage the annulus or aortic root.

TAKE-HOME MESSAGES: Understanding the TAVR prosthesis and surgical plane simplified the explantation process. The lasso technique with a 3D endoscope facilitated explantation, even in high-risk patients.