This study states that Transcatheter aortic valve replacement (TAVR) is an established alternative to surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis.1,2 TAVR use has increased greatly, but the clinical impact and outcomes of surgical TAVR valve implantation and SAVR (TAVR explant) are not well understood.3 Despite the feasibility of a repeat TAVR procedure, there has been an increasing need for TAVR explant as the number of TAVR implants has increased. There are reports of TAVR valves causing neoendothelialization between the device and contacting native tissue (Figure, A and B), making device explantation a more morbid procedure than originally thought.3 The difficulty of SAVR after TAVR may be another consideration for the initial choice of TAVR versus SAVR in younger patients. This study was undertaken to review registry TAVR explant data to better understand the challenges and outcomes of surgical TAVR explant procedures.

This study was approved by the Society of Thoracic Surgeons (STS) and the University of Michigan institutional review board. The data were provided by the STS National Database Participant User File Research program. The data are available from the corresponding author on reasonable request. TAVR explant was defined as a non–same-day surgical TAVR valve explant with SAVR performed in patients who had undergone TAVR. Between 2011 and 2018, 782 patients with TAVR explant were identified. The STS predicted risk of mortality score was available in patients with isolated SAVR. Where available, the observed-to-expected 30-day mortality ratio is reported.

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