Author + information
- Received May 31, 2016
- Accepted June 30, 2016
- Published online October 10, 2016.
- Ayman Jubran, MD,
- Moshe Y. Flugelman, MD,
- Nader Khader, MD and
- Ronen Jaffe, MD∗ ()
- ↵∗Reprint requests and correspondence:
Dr. Ronen Jaffe, Lady Davis Carmel Medical Center, Department of Cardiovascular Medicine, 7 Michal Street, Haifa, Israel 34362.
Accurate valve positioning during transcatheter aortic valve replacement (TAVR) is crucial. Valve migration into the left ventricle during deployment can be treated by pulling the valve toward the aortic root or by implanting a second valve.
An 83-year-old woman with severe symptomatic aortic stenosis (valve area 0.80 cm2) was referred for TAVR. Computed tomographic angiography revealed a mildly calcified tricuspid aortic valve (960 Agatston units), minimal calcification within the ascending aorta, and aortic annular dimensions of 21 × 25 mm. A 29-mm CoreValve (Medtronic, Minneapolis, Minnesota) was implanted without pre-dilation.
Implantation was initiated after optimal valve position had been achieved (Figure 1, Online Video 1), but the valve descended significantly into the ventricle during deployment, resulting in severe aortic regurgitation (Figure 2, Online Video 2). Attempts to pull the valve proximally resulted in intussusception of the aortic annulus into the aorta, with deformation of the aortic root (Figure 3, Online Video 3). The deformity resolved after tension on the delivery system was released. Despite the deep final position of the valve (12 mm below the aortic annulus), contact between the distal sealing skirt and the annulus prevented paravalvular leak (Figure 4, Online Video 4). The temporary aortic root deformation did not result in adverse clinical outcomes, and the patient made an uneventful recovery without need for permanent pacemaker implantation.
This case highlights the need for new-generation retrievable and repositionable valves with improved control of positioning.
For supplemental videos and their legends, please see the online version of this article.
Dr. Jaffe is a medical advisor for MediValve, a startup company developing technology for the optimization of accurate valve deployment during transcatheter aortic valve replacement. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 31, 2016.
- Accepted June 30, 2016.
- American College of Cardiology Foundation