Failed TAVR? Heart surgeons explain TAVR explant, options and risks

Fukuhara: There are several factors that can lead to TAVR valve failure.

In the early years of TAVR, failures were often related to procedural issues, such as valve mispositioning or valve migration. Today, the most common reason is structural valve degeneration, which can occur several years after the valve is implanted.

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 about 20–30% of patients who ultimately require TAVR explant surgery.

The timing of the failure depends on the cause. Procedural complications usually occur early, often within the first few months after implantation. Valve degeneration typically occurs years after the procedure.

When all causes are combined, studies suggest the average time to TAVR failure is approximately three years, although this varies widely among patients.

Is TAVR explant the only option after a failed valve?

Hamilton: Not necessarily. 

The three things to consider with a failed TAVR valve are the reason for failure, the anatomy of the patient and the projected lifetime management of the patient’s aortic valve disease.

In certain cases, a patient might be a candidate for a second TAVR valve. However, all three of the above considerations must be appropriate, or TAVR explant is the only other option for valve replacement. 

What are the surgical risks for a TAVR explant? What is the mortality rate?

Fukuhara: In the early experience with TAVR explant surgery, the procedure carried a relatively high risk, with reported mortality rates approaching 20% in some studies. 

However, outcomes have improved significantly as surgeons have gained experience and as TAVR has expanded to younger and lower-risk patients. 

At U-M Health, recent outcomes in 2025 show operative mortality under 2% — 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 (second TAVR valve inside the first one) is not an option, it is important to seek prompt evaluation from experienced heart valve surgeons.

What’s the long term durability of a new valve (SAVR) after TAVR explant?

Hamilton: Standard bioprosthetic surgical aortic valves tend to last roughly 12-15 years before beginning to experience structural valve degeneration. 

Patient factors will continue to influence the longevity of the valve, with younger patients or patients with kidney disease often experiencing valve failure much earlier. 

However, the surgical aortic valve that is implanted after TAVR explant is the same kind of valve that would be implanted in any SAVR procedure, and excellent durability is expected.

In contrast, due to the more complicated nature of the TAVR explant operation, centers with less experience might struggle to implant an adequately sized valve and end up with a valve that is too small for the patient. This will cause the valve to wear out more quickly. 

Why is experience important for SAVR after TAVR?

Fukuhara: Experience is important because these procedures can be technically complex and require specialized surgical proficiency.

Our team is constantly engaged in clinical research, surgical innovation and surgeon education in the field of TAVR explant.

The Frankel Cardiovascular Center has performed more than 150 TAVR explant procedures, making our center one of the most experienced programs in the world.

Are too many people doing TAVRs?

Hamilton: TAVR remains a fantastic option for older or sicker patients, with the appropriate indications and anatomy. 

However, across the nation, too many younger and healthy patients are being offered TAVR without the appropriate discussion and consideration regarding lifetime management of their disease. 

When should you consider doing SAVR over a TAVR?