Left Ventricle Wire Loss During TAVR: How to Solve it Through Antegrade and Retrograde Approach

Area of Science:

• Cardiovascular Interventions
• Structural Heart Disease
• Medical Device Technology

Background:

• Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure for aortic stenosis.
• Wire loss during TAVR is a rare but significant complication that can impede valve deployment.

Observation:

• During a transfemoral TAVR procedure, the support wire was inadvertently withdrawn from the left ventricle (LV).
• Subsequent attempts to recross the aortic valve using standard techniques were unsuccessful.

Findings:

• A successful bailout strategy involved performing a transseptal puncture to access the LV.
• An arteriovenous loop was created, and a steerable introducer was used for antegrade crossing of the aortic valve.
• A folded Balance Heavyweight wire was utilized to snare the delivery system wire within the LV, enabling valve deployment.

Implications:

• This case highlights the importance of vigilance to prevent wire loss during TAVR.
• Transseptal puncture combined with arteriovenous loop creation and snaring offers a viable bailout option when conventional methods fail.
• This technique can be crucial for successful TAVR completion in challenging wire-loss scenarios.