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

Abstract

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