Key result
Multi-snare in vivo crimping enables non-surgical transseptal retrieval of an embolized Sapien 3 valve.
Why the study?
To describe a technique for salvaging an embolized balloon-expandable valve from the left atrium during transcatheter mitral valve replacement.
Case Report
Describes a novel percutaneous snare-based technique to salvage and retrieve an embolized balloon-expandable valve from the left atrium during transcatheter mitral valve replacement, avoiding emergent surgery.
May enable percutaneous bailout for embolized TMVR valves; leaves open generalizability beyond single-case experience.
OBJECTIVE: Salvaging an embolized balloon-expandable valve (Edwards Sapien 3 Ultra) from the left atrium during transcatheter mitral valve replacement. KEY STEPS: 1) Secure the embolized valve in the left atrium. 2) Use multiple snares to crimp and snare the outflow of the valve into a more conical shape to facilitate valve retrieval. 3) Align the valve in the inferior vena cava to avoid obstruction. 4) Proceed with planned transcatheter mitral valve replacement. 5) Consider closure of the iatrogenic atrial septal defect (ASD). POTENTIAL PITFALLS: Failure to retrieve the valve from the left atrium may require emergent cardiotomy. Improper alignment or insecure deployment of the valve in the inferior vena cava can lead to obstruction or distal embolization. In addition, a large iatrogenic ASD can lead to right ventricular failure. Finally, closure of the ASD without valve replacement will jail future access. TAKE-HOME MESSAGE: In vivo crimping of the outflow of the Edwards Sapien 3 Ultra valve can allow for retrieval of the valve through the atrial septum without surgery.
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Koskina et al. (2026) conducted a case report in Embolized balloon-expandable valve during transcatheter mitral valve replacement. In vivo crimping and snaring of embolized valve was evaluated on Valve retrieval without surgery. In vivo crimping of the outflow of an embolized Edwards Sapien 3 Ultra valve using multiple snares allows for its retrieval through the atrial septum without surgery.
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