The buddy balloon for transcatheter aortic valve replacement: insights from computed tomographic assessment of the...

Transcatheter aortic valve replacement (TAVR) is a procedure whose technique and devices are evolving rapidly, facilitating increased safety and efficacy. However, there remain challenging cases. Considering the concept of crossing a bulky prosthesis through a calcified and narrowed aortic valve, it seems not unexpected that some of these procedures have difficulty. This is in fact rare, but can occur and demands special techniques, since the commercially available balloon-expandable prosthesis and its iterations are not retrievable when inserted into the body. The buddy-balloon technique for TAVR has a similar rationale. Sheiban et al reported the buddy-balloon technique as a solution to failed aortic valve crossing, but it is not widely used, particularly in many lower-volume centers starting to perform TAVR. We report two cases that were effectively treated with the help of this technique.