TAVR Explant: Surgical Aortic Valve Replacement (SAVR) after Transcatheter Aortic Valve Replacement (TAVR)
TAVR Explant: Surgical Aortic Valve Replacement (SAVR) after Transcatheter Aortic Valve Replacement (TAVR)
A TAVR explant is a specialized surgical procedure used to remove and replace a previously implanted Transcatheter Aortic Valve Replacement (TAVR) valve when it is no longer functioning properly or has become infected. While most TAVR valves perform well for expected longevity, some patients, particularly young patients, may require additional treatment over time.
At University of Michigan Health, patients with aortic valve disease are evaluated by a multi-disciplinary heart team that includes cardiologists, cardiac surgeons and imaging specialists. Together, we consider each patient’s anatomy, overall health and long-term goals to recommend the best treatment—whether that is TAVR, surgical valve replacement or another approach.
With more than 30 years of leadership in complex aortic care, our team provides the full spectrum of valve treatments and has extensive experience managing even the most complex valve situations, including TAVR explant surgery.
A TAVR explant is an open-heart surgical procedure performed when a previously implanted TAVR valve is no longer functioning properly or has become infected.
During the procedure, the implanted valve is carefully removed and replaced with a surgical prosthetic valve.
As TAVR use continues to expand, particularly among younger patients, the need for specialized management of complex valve complications has also increased. Although TAVR explant remains uncommon, it is an important option for certain patients and requires advanced surgical expertise.
Several factors can lead to TAVR valve failure.
The most common cause is structural valve degeneration, which may occur years after implantation.
Other causes include:
- Endocarditis (infection of the valve)
- Paravalvular leak (blood leaking around the valve)
- Valve thrombosis (clot formation)
Endocarditis occurs in up to 1% of TAVR patients per year and accounts for roughly 20–30% of patients who ultimately require TAVR explant surgery.
Not necessarily.
At University of Michigan Health, every case is reviewed by our multidisciplinary heart valve team to determine the most appropriate treatment.
When a TAVR valve fails, three factors guide the treatment plan:
- The reason for valve failure
- The patient’s anatomy
- Long-term management of the patient’s aortic valve disease
In some situations, a patient may be a candidate for a second TAVR valve, in which a second valve is placed inside the original valve. In other cases, surgical TAVR explant provides the safest and most durable treatment.
Our Approach
At University of Michigan Health, our cardiac surgery team has the most extensive experience with TAVR explant procedures. Since performing our first TAVR explant in 2016, our surgeons have completed more than 175 procedures, making our center one of the most experienced programs in the world.
This experience matters because TAVR explant procedures are technically complex and require advanced surgical techniques. Our surgeons use specialized methods, including the double Kocher clamp technique, which allows controlled and safe removal of the implanted valve.
Appointment Information
To schedule an evaluation with a Frankel Cardiovascular Center physician, call 888-287-1082. Or visit the Make a Cardiovascular Appointment page to learn what to expect when you call us.
What to Expect
TAVR explant is performed through open-heart surgery. After the heart is safely stopped using standard techniques, the TAVR valve is removed and replaced with a surgical prosthetic valve. An important advantage of TAVR explant is the ability to treat other heart conditions at the same time, if needed.
In most cases, the TAVR valve can be removed without damage to the surrounding tissue. A surgical heart valve is then implanted in standard fashion. In some cases (up to about 7%), there may be injury to the surrounding structures during valve removal, which requires additional repair. At University of Michigan Health, our surgical team has extensive experience managing these complex situations.
Preparation is similar to other open heart surgeries. Maintaining good physical condition before surgery can help support a smoother recovery. Patients are encouraged to stay as active as possible, within their limits, leading up to surgery.
Before surgery, patients undergo a comprehensive evaluation, which may include imaging studies such as CT scans and echocardiograms, as well as blood tests and consultations with the heart team. This evaluation helps determine the safest and most effective surgical plan. However, urgent situations occur and patients may go through urgent procedures. It is important to have these urgent procedures done by an experienced heart surgery team to achieve excellent outcomes despite urgency.
Recovery is similar to other open heart surgeries. After an uncomplicated procedure, the hospital stay is typically 5 to 7 days, including 1 to 2 days in the intensive care unit (ICU). Most patients return to their usual level of activity within 6 to 8 weeks, although recovery time can vary.
Risks & Benefits
In the early experience with TAVR explant surgery, the procedure carried a relatively high risk, with reported mortality rates approaching 20%. However, outcomes have improved significantly as surgeons have gained experience and as TAVR has expanded to younger and lower risk patients.
At the University of Michigan Health, 2025 outcomes show operative mortality under 2%, which is similar to standard surgical aortic valve replacement in experienced centers.
One of the most important factors for good outcomes is timing. Patients who wait too long or become severely ill before surgery may face higher risks. If a TAVR valve fails and redo-TAVR is not an option, it is important to seek evaluation from experienced heart valve surgeons promptly.
There are several benefits. One is allowance of larger heart valves. Second, complete treatment of other heart conditions such as other heart valve problems, aortic aneurysms, infections, blockage of coronary arteries. Larger heart valves have better longevity.
Research
Our team is actively involved in clinical research, surgical innovation, and surgeon education related to TAVR explant surgery. Experience is important because these procedures can be technically complex and require specialized surgical expertise.
Our team is also actively involved in developing new surgical tools and technologies to make TAVR explant procedures safer and more efficient.
Locations
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Cardiac Surgery Clinic | Frankel Cardiovascular Center 1425 E Ann St
Floor 3 Reception C
Ann Arbor, MI 48109-5856Get Directions
Doctors
Gorav Ailawadi, MD, MBA
Professor
Thoracic Surgery, Surgery
Shinichi Fukuhara, MD
Clinical Assistant Professor
Thoracic Surgery, Surgery
Barbara Hamilton, MD, MS
Clinical Assistant Professor
Thoracic Surgery, Cardiac Surgery
Robert Bruce Hawkins, MD, MSc
Assistant Professor
Thoracic Surgery
Himanshu Jagdish Patel, MD
Professor
Thoracic Surgery, Surgery
Bo Yang, MD
Professor
Thoracic Surgery, Surgery
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