Middle aged patient with 3 yo TAVR valve with severe AS, MS and near systemic pHTN. TAVR is a great option for elderly. However, extremely thoughtful rationale is needed for younger patients. Otherwise we will be busy explanting these valves 10 years from now.

Michigan VIR and Michigan CT Surgery Residency with new technique for endovascular mgmt of dissection flaps in chronic TBAD with aneurysm degen. IVUS, steerable sheath, and LASER septotomy facilitates TEVAR and may improve false lumen thrombosis and aortic remodeling. bit.ly/33ijhU2

Pulmonary artery dissection associated with aortic arch aneurysm and aortopulmonary artery fistula in a patient with failed endovascular total arch repair

This is just a piece of puzzle previous TAVR studies were completely missing. What’s more important is Explant-TAVR to Repeat-TAVR ratio in patients with failing TAVR valve. We are getting ready to share the Michigan statewide data soon.

Few things in life are permanent. Understanding the potential for surgical explant of #TAVR Alex Brescia P Michael Grossman, MD Devraj Sukul, MD MS Melissa Clark Stan Chetcuti Shinichi Fukuhara, MD Michigan CT Surgery Residency Michigan Cardiology MSTCVS Quality Collaborative U-M Health Frankel CVC #AHAJournals #cardiotwitter ow.ly/rBtq50DZ0Hq

Important learning and discussions taking place about #TAVR explant, risks and outcomes, techniques for balloon expandable and self-expanding valve explantation, and the need for a heart-team approach. #TAVR2021

Historically, we were only looking at "common" carotid artery. However, "internal" carotid artery may be a surrogate marker for dismal outcomes. Some of patients with postop brain herniation might have had "internal" carotid occlusion. We just didn't know without head & neck CTA.

I am thrilled to take this role of our program—one of the most prestigious training programs in the country. We are aiming to make our program even better, providing unparalleled clinical and operative experiences and limitless research opportunities for our trainees.

This is how a persistent type 2 endoleak looks like inside.

Ross after TAVR in a reoperative setting.

Purulent pericardial effusion with tamponade secondary to ruptured distal aortic arch.

University of Michigan aortic surgeons at the statue of Chuken Hachiko, the most well-known landmark for meeting people in Japan. Hachiko is a faithful Akita dog who waited at Shibuya Station every day for his master, even after his death. Bo Yang

Thank you Gilbert. Mortality risk for isolated redo SAVR is higher after TAVR as compared to SAVR. The number of reoperation after VIV-TAVR is high, despite the small denominator. Reoperation after VIV-TAVR is not as risky, but VIV-TAVR durability may not be as good as we think.

Congrats Gilbert. Previous studies have reported the frequency from redo-TAVR and EXPLANT independently, and there was little understanding related to each treatment. This is the first study revealing the two treatment pathways across the same centers and that is the true value.

TAVI Explantation Remains a Risky Proposition, Two New Studies Show tctmd.com/news/tavi-expl… (with Dr. Gilbert Tang, Tsuyoshi Kaneko, and Shinichi Fukuhara, MD).

The no. of post-TAVR reoperations is 📈 & represent a high-risk population. Yet even in isolated #SAVR cases, SAVR after #TAVR is independently assoc w/ ⬆️ risk of mortality. Pts w/ life expectancy beyond TAVR valve should consider a SAVR-first approach. bit.ly/42gyBgQ

#AATS2023 Reoperation Following Transcatheter Aortic Valve Replacement: Insights From 10-Year Experience. Read the #JTCVS article by Shinichi Fukuhara, MD, Deeb, et al: doi.org/10.1016/j.jtcv… #TAVR #aorticvalve AATS CTSurgSocMedNetwork Karen M Kim, MD Bo Yang Matthew Romano Gorav Ailawadi