Surgical Explant of Degenerated Transcatheter Valves: A New Type of Threat?

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Abstract
Objectives: Transcatheter treatment for valvular heart diseases has markedly expanded its indications due to reduced invasiveness and hospitalization time. Despite favourable results, several peculiar and more frequent shortcomings than occur with a surgical-based implant have been reported. This review provides the currently available information regarding a transcatheter heart valve (THV) implant and reoperation, focusing on recent available data about surgical management strategies for THV degeneration. Methods: For this narrative review, we searched Medline through the end of March 2025 using medical subject headings and text words supplemented by scanning the bibliographies of recovered articles. The terms “transcatheter valve degeneration,” “TAVI degeneration,” “surgical treatment,” and “surgical explant” have been combined using the Boolean operator “AND”. Results: Currently available articles focus specifically on the aortic THV explant. Peculiar intraoperative (like coronary ostium, aortic wall and annular injury due to THV explant) or short-term postoperative complications related to THV explant have been reported. Thirty-day mortality has been shown to range between 12% and 32.6%, and only short and heterogeneous follow-up periods are available to date. A careful work-up to indicate that the valve-in-valve procedure is not feasible or not appropriate when facing degenerated THV and a cautious, detailed plan of the surgical explant have been recently recommended. Conclusions: THV explants due to valve degeneration are rapidly increasing, but, due to the related risk for intra- and post-procedural complications, careful preoperative evaluation and intraoperative handling are warranted.

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