Pusher preventing maximum expansion of transfemoral transcatheter valves

To report on 2 rare cases of balloon-expandable transfemoral transcatheter aortic valve implantation, where a trapped balloon led to complications requiring acute intervention. Both patients were elderly with increased risk profile and had been discussed by the heart team. After standard positioning of the valves using a transfemoral approach, retrieval of the pusher before deployment of the valve was missed. In 1 patient, rapid pacing was continued, the balloon deflated, the pusher pulled back and the balloon repositioned and reinflated. In the other patient, valve migration into the left ventricle occurred. A second valve was deployed. The embolized valve was then recovered from the ventricle via transapical access. Complications can occur in transcatheter aortic valve implantation, even when they are very rare. A predeployment check list, indicating key procedural steps on a standardized basis, should always be followed to easily prevent mishaps.