Related Experiment Video
Updated: Sep 14, 2025
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
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.
Objective:
To highlight a novel and strategic approach to managing a malpositioned transcatheter aortic valve replacement valve using a double-snare-assisted reimplantation strategy.
Key Procedural Steps:
Key procedural steps include maintaining guidewire access through the valve, using a True Flow balloon to enhance control over valve maneuverability and repositioning, applying a crisscross double-snare technique allowing the valve to fold inward and minimize aortic trauma, carefully repositioning the valve to a desirable location in the aorta, maintaining control of the mobilized valve with a snare, and finally, properly implanting a new valve.
Potential Pitfalls:
Potential risks and complications of the procedure include aortic trauma, stroke, valve entanglement, and undesirable valve embolization as well as the possible need for conversion to open heart surgery.
Take-Home Messages:
The double-snare-assisted repositioning technique may offer a feasible percutaneous approach for managing malpositioned transcatheter aortic valve replacement valves. Given the increasing frequency of high-risk valve-in-valve procedures, clinicians should aim to enhance their expertise in managing these challenging complications.
