Valve embolization with a second-generation fully-retrievable and repositionable transcatheter aortic valve

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Device Technology

Background:

• Transcatheter aortic valve implantation (TAVI) has revolutionized aortic valve replacement.
• First-generation TAVI valves were associated with rare but serious complications like valve embolization.
• Second-generation TAVI valves were developed with enhanced retrievability and repositionability to mitigate risks.

Observation:

• This report details the first documented case of embolization involving a second-generation, fully retrievable Lotus valve.
• The complication occurred in a patient with severe left ventricular hypertrophy and a sigmoid septum.
• Initial implantation of a 23mm Lotus valve at a high position may have been compromised by septal bulging, leading to distal embolization.

Findings:

• A subsequent implantation with a 25mm Lotus valve, utilizing a lower height and oversizing for increased radial strength, achieved greater stability.
• The "watermelon seeding" phenomenon, where the septum dislodges the valve, was observed.
• This case underscores the potential for valve embolization even with newer TAVI technologies.

Implications:

• Meticulous pre-TAVI assessment of subvalvular geometry, especially severe hypertrophy, is crucial for device selection and implantation strategy.
• Consideration of self-expanding prostheses or lower implantation heights with oversized valves may enhance stability.
• Higher implantation of the Lotus valve in hypertrophic patients may increase the risk of embolization and necessitate careful planning.