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Structural Valve Failure During Transcatheter Aortic Valve Replacement: Infolding, Deformation, Embolization, and
Willette Valjean P Go1, Victorio Luis Gabriel N Javier1, Christopher Bernard D L R Javier1
1Department of Medicine, Section of Cardiology, Makati Medical Center, Makati City, Philippines.
Objectives:
Infolding, deformation, and embolization are forms of valve failure linked to significant complications. We report a successful same-procedure bailout redo-transcatheter aortic valve placement (redo-TAV) approach after failure of the index transcatheter aortic valve replacement.
Key Steps:
An Evolut 34-mm valve showed infolding with vertical-line sign after deployment. Postdilatation with a NuMED 25-mm balloon caused deformation, embolization, and significant aortic regurgitation. Bailout redo-TAV rescue with a second Evolut 34-mm valve was positioned around 1-mm deeper. Final postdilatation with a NuMED 26-mm balloon resolved paravalvular leak and gradients and improved the transcatheter heart valve configuration.
Complication Prevention Strategy:
Careful verification of proper Evolut valve loading prior to insertion-along with timely recapture, resheathing, and retrieval before final deployment when abnormalities are identified-could have prevented this complication. Tall-in-tall redo-TAV may impair coronary reaccess and increase coronary obstruction risk.
Take-Home Message:
Early detection of misloading and infolding is essential to prevent severe transcatheter heart valve deformation and may help avoid the complications related in the case.
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