Successful Bailout for Transcarotid Delivery Failure of Transcatheter Aortic Valve

Transcarotid-transcatheter aortic valve implantation (TC-TAVI) generally enables smooth transcatheter heart valve crossing given its proximity to the aortic annulus; however, severe anatomical constraints may still lead to delivery failure. We report a TC-TAVI case in which transcatheter heart valve passage across the aortic valve was initially unsuccessful because of aortic angulation and extensive leaflet calcification. This technical difficulty was effectively resolved using the buddy balloon technique, which enabled successful valve advancement. This case demonstrates that the superior pushability of the TC approach may not overcome extreme anatomical resistance, necessitating predilatation aggressively indicated for such challenging anatomies.

Pronounced aortic angulation and severe leaflet calcification can hinder transcatheter heart valve delivery, even during TC-TAVI, where easier valve crossing is typically anticipated. These anatomical factors remain significant predictors of delivery failure, irrespective of the vascular access route.