Corevalve Explantation through a Minimally Invasive Inferior Ministernotomy

This video shows an 81-year-old male patient with severe calcified aortic stenosis. He had several previous abdominal surgeries and presented with clinical frailty. LVF was 40% and there were no coronary lesions at the left heart catheter. The EuroScore I was 14.1%, EuroScore II was 2.8%, and the STS score was 4.1%. The case was debated by the heart team, and it was decided to implant a 31 mm Corevalve. The valve was implanted trough a classic transfemoral approach. During the initial hospitalization, a grade I/II aortic insufficiency was detected. This was due to a paravalvular leak, which seemed stable and without any clinical relevance. The patient was then discharged.

 

The patient was readmitted twice in two months for congestive heart failure. Transthoracic echocardiography showed a much more important aortic insufficiency (grade III/IV). The Corevalve had migrated to a lower position at the level of the left outflow tract. The patient refused a new TAVR and chose surgery. Clear information about the high operative risk was provided.

 

In order to reduce the surgical trauma, the authors planned a minimally invasive ministernotomy approach. A CT scan, performed on all patients with aortic stenosis, showed that the aortic annulus would be better approached by an inferior ministernotomy. This was an unusual anatomical situation, which highlights the importance of the preoperative work-up (especially the CT scan) in planned minimally invasive procedures. This video shows the surgical exposure and management of the Corevalve explantation.