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Salvaging Percutaneously a Suboptimal TAVR Deployment with Repositioning In the Thoracic Aorta: A Novel
Sandeep M Patel1, Hafez Golzarian2, Anna C Kleman1
1Structural Heart & Intervention Center, Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA.
JACC. Case Reports
|July 19, 2025
Summary
A new double-snare technique helps reposition malpositioned transcatheter aortic valve replacement (TAVR) valves during procedures. This strategy aims to reduce aortic trauma and improve patient outcomes in complex TAVR cases.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- Transcatheter aortic valve replacement (TAVR) is a common procedure for aortic stenosis.
- Valve malpositioning is a rare but serious complication during TAVR.
- Managing malpositioned TAVR valves percutaneously presents significant challenges.
Observation:
- A novel double-snare-assisted reimplantation technique is described for managing malpositioned TAVR valves.
- Key steps involve maintaining guidewire access, using a balloon for maneuverability, and employing a crisscross double-snare technique.
- This method facilitates controlled valve folding, minimizes aortic trauma, and allows precise repositioning.
Findings:
- The double-snare technique enables effective percutaneous management of malpositioned TAVR valves.
- It allows for controlled repositioning and subsequent implantation of a new valve.
- Potential complications include aortic trauma, stroke, and valve embolization, with possible conversion to open surgery.
Implications:
- This technique presents a feasible percutaneous option for a challenging TAVR complication.
- Enhanced expertise in managing malpositioned valves is crucial given the rise in valve-in-valve procedures.
- Further studies may validate the safety and efficacy of this approach in diverse patient populations.
