Surgical explant of degenerated transcatheter valves: a new type of threat?

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 in surgical-based implantation have been reported. This review aims to provide the currently available information regarding transcatheter valve (THV) implantation 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", "surgical explant" have been combined using the Boolean operator 'AND'. Results: Currently available literature specifically focuses on 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 to 32.6%, and only short and heterogeneous follow-up periods are available to date. Careful work-up to indicate that valve-in-valve procedure is unfeasible or not appropriate when facing degenerated THV, and a cautious as well as detailed planning of surgical explant have been recently recommended. Conclusions: THV explant due to valve degeneration is rapidly increasing, but, due to its related risk for intra and post-procedural complications, a careful pre-operative evaluation and intraoperative conduct are warranted.