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

Wire loss during transcatheter aortic valve replacement (TAVR) can be troublesome.

An 88-year-old man with aortic stenosis underwent transfemoral TAVR with a nonretrievable device. During valve insertion, the extra support wire was withdrawn from the left ventricle (LV). Attempts to recross the valve were unsuccessful. The authors performed a transseptal puncture and used a steerable introducer to cross the aortic valve antegradely with a hydrophilic wire, which was externalized to form an arteriovenous loop. A folded Balance Heavyweight wire (Abbott Vascular) was used to snare the delivery system wire into the LV and deploy the valve.

Our case exemplifies several challenges that may occur during TAVR, including wire loss, and how to solve them.

Attention must be paid to avoid LV wire loss during TAVR. Transseptal puncture with an arteriovenous loop and snaring can be used for bailout when other techniques are unsuitable or have failed.