TAVR Explant in the Era of Lifetime Valve Management: Indications, Operative Challenges, and Contemporary Outcomes.

PURPOSE OF REVIEW: This review summarizes contemporary evidence on transcatheter aortic valve replacement (TAVR) explantation, emphasizing epidemiology, indications, operative challenges, outcomes, risk prediction, and implications for lifetime valve management. RECENT FINDINGS: As TAVR expands to younger and lower-risk patients, explantation is becoming an increasingly relevant component of lifetime valve care. Recent systematic reviews, registries, national databases, and center experiences show that TAVR explant is technically complex, frequently requires concomitant procedures, and carries early mortality that exceeds conventional risk predictions. TAVR-in-TAVR is feasible in selected patients with structural valve degeneration but may be limited by infection, small annulus, coronary obstruction risk, or impaired future coronary access. TAVR explant should be considered during index valve selection. Heart Team planning should incorporate durability, coronary access, annular size, redo-TAVR feasibility, and surgical explant complexity, particularly in younger patients.