Transcatheter Aortic Valve Replacement (TAVR)/Transcatheter Aortic Valve Intervention (TAVI) and TAVR/TAVI Explants
Key takeaways
Transcatheter Aortic Valve Replacement (TAVR), also sometimes called Transcatheter Aortic Valve Implantation (TAVI), is a modern, minimally invasive procedure that replaces a damaged aortic valve.
Transcatheter Aortic Valve Replacement/Intervention (TAVR/TAVI) is a minimally invasive, catheter-based procedure that replaces a narrowed aortic valve without opening the chest.
A TAVR/TAVI procedure is used to treat severe aortic stenosis and aortic regurgitation. It is especially used in older adults or high-risk surgical patients.
A TAVR/TAVI explant is the highly specialized open-heart surgical removal of a previously implanted TAVR/TAVI valve that has failed, worn out or become infected.
Driven by TAVR/TAVI usage in younger patients, TAVR/TAVI explant surgery is currently the fastest-growing cardiac surgery procedure in the United States.¹
Removing a failed TAVR/TAVI valve requires exceptional precision. This is because the metal stent framework can integrate with the aortic wall over time. Performing this complex procedure at a high-volume center like the UF Health Aortic Disease Center drastically improves success and survival rates.
Understanding the aortic valve and how it fails
The aorta is the largest artery in the body. It acts as the main highway that delivers oxygen-filled blood from your heart to your brain and limbs. Blood leaves the heart and enters the aorta through a one-way gate called the aortic valve.
A healthy aortic valve opens completely to let blood rush out, then seals tightly to prevent blood from leaking backward. When this valve becomes diseased, it generally falls into two categories:
Aortic Stenosis: Over time, calcium deposits can accumulate on the valve's leaflets. This makes them stiffer and thicker. The valve can no longer open fully. This restricts normal blood flow and forces your heart to work harder than it should to pump blood out.
Aortic Regurgitation: The valve fails to close completely. This allows a steady backward flow of blood into the heart.
What is TAVR?
Transcatheter Aortic Valve Replacement (TAVR), also sometimes called Transcatheter Aortic Valve Implantation (TAVI), is a modern, minimally invasive procedure that replaces a damaged aortic valve.
Traditional valve surgery requires open-chest surgery and a heart-lung bypass machine. In contrast, TAVR/TAVI is performed from the inside of your blood vessels. The surgeon threads a long, thin, flexible tube called a catheter through an artery, usually through an incision in the groin.
At the tip of the catheter is a collapsed, biological replacement valve made of natural tissue supported by a metal mesh frame. Once the catheter reaches the heart, a small balloon expands the new valve directly inside your old, diseased valve. The new valve immediately opens, pushes the old valve leaflets aside, and assumes control of blood flow.
Benefits of TAVR/TAVI
Because TAVR/TAVI avoids a large incision through the breastbone, it offers significant advantages for eligible patients:
Significantly less physical pain and reduced blood loss.
A dramatically lower risk of post-operative infection.
Faster recovery time, with most patients returning home within three to five days.
Preparing for and recovering from TAVR/TAVI
Before the procedure
To make sure you have a safe and successful procedure, patients must follow these steps:
Dental Clearance: It might not be something you think about, but you must see a dentist to ensure there are no active infections in your mouth. Left untreated, bacteria from the mouth can enter the bloodstream and attach to your new heart valve, causing a dangerous infection.
Medication adjustments: Two weeks before surgery, you will likely be asked to stop taking blood-thinning medications or NSAIDs. This might include aspirin, ibuprofen or Aleve, to lower bleeding risks.
Fasting: You must not eat or drink anything, including chewing gum or breath mints, after midnight the night before your procedure.
Aftercare and follow-up
The first night following your TAVR/TAVI will be spent in the Cardiovascular Intensive Care Unit (CVICU) under close observation. Most patients are helped out of bed to walk by the very next day.
Before going home, your care team will show you how to:
Properly clean your small groin incision
Manage your diet
Safely rebuild your strength.
Because biological valves can wear down over time, you will need regular, lifelong follow-up appointments. You will also need echocardiograms (ultrasounds of the heart) to ensure the valve continues to function perfectly.
Expert care at the UF Health Aortic Disease Center: TAVR/TAVI explant surgery
While TAVR/TAVI is highly successful, it is not always a permanent fix. Biological tissue valves have a limited lifespan and naturally degrade over time. Furthermore, as TAVR/TAVI has grown in popularity, it is increasingly being performed on younger, more active patients who outlive their first transcatheter valve.
When a TAVR/TAVI valve fails, a patient may sometimes receive a second TAVR/TAVI valve placed inside the first one (a "valve-in-valve" procedure). However, if the patient's anatomy is too tight or if the valve is severely damaged, a TAVR/TAVI explant is required.
A TAVR/TAVI explant is an advanced open-heart surgery. During the procedure, a surgeon stops the heart, opens the aorta, carefully cuts out the failed TAVR/TAVI valve, and replaces it with a traditional surgical aortic valve.
Why TAVR/TAVI explants are highly complex
Unlike a standard valve replacement, a TAVR/TAVI explant is exceptionally challenging. When a TAVR/TAVI valve is deployed, its metallic stent frame puts constant outward pressure against the inside of your aorta. Over months and years, the body's natural healing process causes scar tissue to grow over and through this metal mesh.
Essentially, the TAVR/TAVI valve becomes deeply embedded in the delicate wall of the aortic root. Removing it requires an elite level of surgical skill. This is because the surgeon has to carefully peel the metal mesh away from the thin tissue of the aorta without tearing the blood vessel, damaging the coronary arteries, or destroying the structural foundation of the heart.
Not many cardiothoracic surgeons perform this procedure, and you want someone with extensive experience in TAVR/TAVI explants. However, at the UF Health Aortic Disease Center, multiple surgeons regularly perform these complex explants with excellent outcomes.
Common reasons for a TAVR/TAVI explant
Structural Valve Degeneration: Natural wear and tear that causes the biological leaflets to stiffen or tear years after the procedure.
Endocarditis Infection: A severe bacterial infection of the valve framework. Because bacteria hide inside the metal mesh, antibiotics alone rarely cure it, making surgical removal necessary.
Patient-Prosthesis Mismatch: This occurs when the implanted TAVR/TAVI valve is too small to meet the patient's resting oxygen and blood flow demands.
Frequently asked questions
What is the main difference between TAVR/TAVI and SAVR?
TAVR/TAVI is a minimally invasive procedure where a new valve is guided through an artery via a catheter and expanded within your old valve without opening the chest. SAVR (Surgical Aortic Valve Replacement) is a common term for traditional open-heart surgery in which the surgeon opens the chest, removes the old valve entirely and sews a new mechanical or tissue valve in its place.
How long does a TAVR/TAVI valve typically last?
Most modern TAVR/TAVI valves are expected to last about 10 to 12 years. However, its longevity depends heavily on the patient's age and overall health. Younger patients or those with advanced kidney disease often have biological tissue valves degrade much faster.
Why is a TAVR/TAVI explant riskier than a standard valve surgery?
During a standard repeat valve surgery, a surgeon simply snips the stitches holding an old surgical valve in place. In a TAVR/TAVI explant, the metal mesh framework has literally fused into the living tissue of your aortic wall. Peeling it out safely requires an incredibly precise dissection to avoid catastrophic tearing of the primary artery.
Can a failed TAVR/TAVI valve always be fixed with a second TAVR/TAVI?
No. While a "valve-in-valve" TAVR/TAVI is an option for some, adding a second layer of metal mesh inside an already crowded space can block the critical coronary arteries that supply blood directly to the heart muscle. If a patient is young, has a small aortic root, or is suffering from a valve infection (endocarditis), a surgical AVR/AVI explant is typically the only safe option.
Why choose the UF Health Aortic Disease Center?
The UF Health Aortic Disease Center is a premier national leader in complex and reconstructive cardiac care. Because TAVR/TAVI explants are highly intricate, national data clearly show that patient survival and success rates are directly tied to hospital volume. Our multidisciplinary center brings together top-tier cardiothoracic surgeons, interventional cardiologists and advanced imaging specialists. We regularly handle the most complex aortic valve failures and advanced explant thoracic surgery, offering life-saving options, clinical trial choices and structural repairs that are not available at most regional medical centers.
To learn more about our comprehensive valve programs or to schedule an appointment, please contact the UF Health Aortic Disease Center by calling (352) 273-5494.
¹ Brescia AA, et al. Transcatheter aortic valve replacement explant: various techniques. Annals of Cardiothoracic Surgery. 2025;14(2). PMCID: PMC12013762.
This entry was written by Gabrielle Massari, Marketing Content Writer, and reviewed for accuracy by Eric Jeng, MD. Generative AI was leveraged as part of the content creation process.