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Buddy Wire Technique for Rescuing an Embolized TAVR Valve
Hunter Row1, Wade Hopper1, Ismail Bekdash2
1Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA.
Objective:
To describe successful endovascular rescue of an incompletely deployed Sapien 3 Ultra Resilia valve that embolized to the ascending aorta during transcatheter aortic valve replacement (TAVR).
Key Steps:
Safari wire access through the valve was maintained. The catheter was upsized to a 7-F JR4, and a 0.035-inch Lunderquist wire was advanced using the buddy wire technique. A 12-mm EverCross balloon was advanced through the valve, partially inflated, and manipulated to restore coaxial alignment. The valve was then fully expanded in the descending aorta. The patient remained stable, and the procedure was completed with deployment of a second valve in the aortic annulus.
Potential Pitfalls:
Loss of guidewire access through an embolized valve may preclude endovascular salvage and necessitate surgical retrieval. Aggressive balloon manipulation risks aortic injury.
Take-Home Messages:
Endovascular recovery of an embolized TAVR valve can be safely achieved using coronary techniques. Familiarity with bailout strategies is essential.
