Surgical Explantation of Transcatheter Aortic Valves: A Contemporary Analysis of Indications and Outcomes.

Transcatheter aortic valve replacement (TAVR) has transformed the treatment of severe aortic stenosis across all surgical risk profiles. However, as TAVR expands into younger, lower-risk populations with longer life expectancies, the management of late bioprosthetic failure has emerged as a critical clinical challenge. While valve-in-valve TAVR offers a less-invasive reintervention strategy, absolute anatomical contraindications frequently render it infeasible, necessitating surgical explantation. Driven primarily by structural valve deterioration, acute device failure, and prosthetic valve infective endocarditis, TAVR explantation presents a uniquely hostile operative field. Unlike traditional redo-surgical aortic valve replacement, the endothelialized and fibrotic integration of transcatheter stent frames into the aortic root and subvalvular apparatus significantly complicates extraction. These procedures often require complex, unplanned concomitant reconstructive procedures. Consequently, explantation carries a substantial morbidity and mortality burden that significantly eclipses native redo-surgical aortic valve replacement, with a stark volume-outcome relationship highlighting the necessity of institutional expertise. This review synthesizes contemporary data from high-volume international registries to evaluate the evolving landscape of TAVR explantation, detailing the primary indications, anatomical hurdles, and clinical outcomes. Ultimately, we emphasize the necessity of rigorous, computed tomography-based lifetime management protocols at the time of the index procedure and the regionalization of explant operations to specialized multidisciplinary structural heart centers to mitigate the severe surgical risks of transcatheter valve failure.