Minimally Invasive TAVR Explantation and Aortic Valve Replacement in a Patient With a Retrosternal Conduit.

backgroundReports of minimally invasive approaches, such as right minithoracotomy, for valve surgery after transcatheter aortic valve replacement (TAVR) are limited, particularly in patients undergoing retrosternal esophageal reconstruction. CASE SUMMARY: A 78-year-old woman with a retrosternal colonic conduit postesophagectomy underwent transfemoral TAVR 4 years ago. She presented with progressive dyspnea due to structural valve degeneration. Valve-in-valve TAVR was unsuitable because of the anticipated patient-prosthesis mismatch. A right minithoracotomy was performed to avoid conduit injury. The degenerated prosthesis was safely explanted using traction sutures and forceps-assisted crushing, and a sutureless prosthesis was implanted. Concomitant mitral and tricuspid annuloplasty and excision of the left atrial appendage were also performed. Postoperative echocardiography confirmed normal function of the implanted aortic valve. DISCUSSION: When valve-in-valve TAVR is not feasible, minimally invasive TAVR explantation via right minithoracotomy may be considered to avoid conduit injury. TAKE-HOME MESSAGES: TAVR explantation and redo aortic valve replacement can be safely performed via the right minithoracotomy approach. In patients undergoing retrosternal conduit reconstruction, a right minithoracotomy approach is useful for avoiding conduit injury. Pericardial suspension allows the reconstructed conduit to be held and effectively protected during the surgery.