Transcatheter aortic bioprosthesis dislocation: technical aspects and midterm follow-up

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Device Technology

Background:

• Prosthesis dislocation is a rare but significant complication during transcatheter aortic valve implantation (TAVI).
• Limited data exists on the performance of dislocated aortic valve prostheses.
• Investigating dislocation mechanisms of the CoreValve ReValving™ System (CRS) is crucial.

Purpose of the Study:

• To investigate the causes of CoreValve ReValving™ System (CRS) prosthesis dislocation during TAVI.
• To assess the midterm outcomes of patients experiencing prosthesis dislocation.
• To analyze the performance of dislodged CRS devices in the aorta.

Main Methods:

• Retrospective analysis of 176 consecutive TAVI procedures using the CRS prosthesis.
• Classification of dislocation mechanisms into accidental, repositioning-related, and intentional bailout.
• Midterm clinical follow-up of patients with dislocated CRS devices.

Main Results:

• Seven patients (3.9%) experienced acute CRS dislocation.
• Dislocations occurred during early use of the Accutrak™ delivery system.
• Dislodged devices functioned normally without migration or structural deterioration; no thromboembolic events occurred.

Conclusions:

• TAVI prosthesis dislocation can be managed by implanting a second device, leaving the dislodged device safely in the aorta.
• Intentional repositioning of dislodged CRS devices is feasible and safe for experienced operators.
• Midterm follow-up shows no serious adverse events related to managed prosthesis dislocations.