TAVR-in-TAVR Retrieval During Cardiac Arrest Using a Modified Double Snare Technique

TAVR embolization and coronary occlusion are two rare but potentially fatal complications which may require operators to conduct an urgent valve retrieval using a snare. Moreover, implantation of a second valve is sometimes necessary to ensure a first inadequate position, which increases the risk of coronary occlusion due to sinus sequestration. We present the case of an 85-year-old patient who suffered a cardiac arrest due to massive aortic regurgitation after partial proximal embolization of a first TAVR. An emergent overlapped second valve in an annular position was implanted, but after postdilation, right sinus sequestration was observed, which was immediately complicated with a new cardiac arrest. In this situation and given the impossibility of retrieving the two overlapping valves using a single loop, an effective removal toward the ascending aorta was achieved using a double-snare technique placed on adjacent crowns, restoring the patient's spontaneous circulation and allowing the implantation of a third TAVR.