Key result
Buddy balloon technique resolves valve delivery failure during TC-TAVI with severe aortic angulation and calcification.
Why the study?
Severe anatomical constraints may still lead to transcatheter heart valve delivery failure during transcarotid-transcatheter aortic valve implantation despite its proximity to the aortic annulus.
Case Report (n=1)
The buddy balloon technique can successfully overcome transcatheter heart valve delivery failure during transcarotid TAVI in patients with severe aortic angulation and calcification.
May aid delivery in complex TC-TAVI anatomies; leaves open safety and efficacy in prospective series.
CASE SUMMARY: 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. TAKE-HOME MESSAGES: 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.
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Miyamoto et al. (2026) conducted a case report in Aortic valve disease requiring TC-TAVI (n=1). Buddy balloon technique during TC-TAVI was evaluated on Successful valve advancement. The buddy balloon technique successfully resolved transcatheter heart valve delivery failure during transcarotid-TAVI caused by severe aortic angulation and extensive leaflet calcification.
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