Rescue and Redeploy: Successful Valve-in-Valve Implantation After Transcatheter Aortic Valve Embolization.

Abstract

Background: Pacing failure is a common cause of transcatheter aortic valve replacement (TAVR) malposition and embolization. Transcatheter aortic valve embolization that compromises aortic branches usually necessitates open surgery. However, a salvage technique can address this complication percutaneously.

Case summary: We report a case involving a 26 mm Edwards transcatheter valve that was cephalically embolized during rapid pacing due to ventricular tachycardia with a single capture beat. The semiinflated embolized valve was successfully pulled back to a position just distal to the left subclavian artery. Subsequently, a second 26 mm valve was implanted through the embolized valve and deployed successfully in the correct position.

Conclusion: Carefully pulling back the embolized transcatheter aortic valve (TAV) to the area distal to the left subclavian artery is a viable salvage technique for embolized TAV. Another attempt of TAVR through the embolized valve can be safely performed, with careful monitoring of left ventricular capture during rapid pacing.Clinical ImpactQuestion: Can transcatheter aortic valve (TAV) embolization be solved percutaneously? Findings: The semi-inflated embolized valve was successfully pulled back to a position just distal to the left subclavian artery. Subsequently, a second 26 mm valve was implanted through the embolized valve and deployed successfully in the correct position. Results: Carefully pulling back an embolized TAV to the descending aorta is a viable salvage technique for managing embolized TAV.