Case Report: Selective metal cell excision during open TAVR implantation preserves coronary access while maintaining valve integrity and function
By
Julia E. Katter
John Paul Tannous
Katherine A. Roberts
Shawn M. Ahmad
Michael N. Young
Henry J. Tannous
May 29, 2026
Clinical Scorecard: Case Study: Targeted Metal Cell Removal During Open TAVR Procedure Preserves Coronary Access and Ensures Valve Functionality
At a Glance
Category Detail
Condition Severe prosthetic stenosis and moderate paravalvular leak post-TAVR Key Mechanisms Selective metal cell excision to preserve coronary access and maintain valve functionality Target Population High-risk patients requiring TAVR explants and root enlargement SAVRs Care Setting Cardiac surgical intervention
Key Highlights
78-year-old female with severe prosthetic stenosis and moderate PVL Open surgical TAVR explantation with selective metal cell excision performed Immediate resolution of stenosis and elimination of PVL Sustained clinical improvement at six-month follow-up Preservation of coronary access for future interventions Guideline-Based Recommendations
Diagnosis
Assess for severe prosthetic stenosis and paravalvular leak in post-TAVR patients Management
Consider open surgical TAVR explantation with selective metal cell excision in high-risk patients Monitoring & Follow-up
Regular follow-up for functional status and echocardiographic assessment post-procedure Risks
Increased surgical risk associated with TAVR explantation and SAVR Patient & Prescribing Data
Patients with degenerated TAVR and significant comorbidities
Selective metal cell excision is a feasible approach to maintain coronary access
Clinical Best Practices
Evaluate coronary anatomy and future intervention needs prior to TAVR Utilize echocardiography to assess valve function post-procedure Consider patient comorbidities when planning surgical interventions Related Resources & Content
