Single-Access Retrieval of a Ruptured Balloon During Balloon-Expandable TAVI

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Low-flow low-gradient aortic stenosis undergoing transfemoral balloon-expandable TAVI complicated by balloon rupture and distal fragment retention (n=1). Intervention: Same-access snare-based retrieval through the ipsilateral 16-F E-sheath after sheath tip straightening with a 0.035-inch J-tip guidewire. Primary outcome: Successful extraction of retained distal balloon fragment and nosecone without vascular injury or surgical conversion.

Q: What does this research mean for the field?

Same-access snaring through the ipsilateral expandable sheath, after correcting sheath tip deformation, enables safe and effective retrieval of retained ruptured TAVI balloon fragments without requiring contralateral large-bore access or surgical conversion. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Anass Maaroufi; Sander Ijsselmuiden; Suzanne Kats

doi:10.1016/j.jaccas.2026.109111

July 1, 2026JACC Case ReportsOpen Access

Single-Access Retrieval of a Ruptured Balloon During Balloon-Expandable TAVI

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Key result

Same-access snaring retrieves a ruptured TAVI balloon through an ipsilateral sheath without vascular injury.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

Balloon rupture with distal fragment retention during balloon-expandable TAVI is a rare, technically demanding complication lacking a standardized retrieval protocol.

Key Points

To describe a single-access endovascular technique for retrieving a retained distal balloon fragment following balloon rupture during transfemoral transcatheter aortic valve implantation.
Procedural management of a 79-year-old patient undergoing transfemoral TAVI with a 29 mm balloon-expandable valve via a 16-F expandable sheath.
Following balloon rupture during valve deployment and resulting sheath tip buckling, a 0.035-inch J-tip guidewire with gentle traction was used to restore coaxial sheath alignment.
An endovascular snare system was advanced through the straightened sheath to engage the retained nosecone and extract the distal balloon segment.
Aortography confirmed no annular rupture or aortic dissection, and the valve remained well positioned with satisfactory expansion and stable hemodynamics.
The retained nosecone and balloon fragment were completely retrieved through the ipsilateral sheath without requiring contralateral large-bore access or surgical conversion.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 male patient (age 79) with low-flow low-gradient aortic stenosis and reduced LVEF (35%) undergoing transfemoral TAVI complicated by balloon rupture, followed for 6 weeks.

I

Intervention

Single-access retrieval of the retained distal balloon segment and nosecone through the ipsilateral 16-F E-sheath using an endovascular snare system (EN Snare) after correcting sheath tip deformation with a 0.035-inch J-tip guidewire and gentle external traction.

O

Outcome

Successful percutaneous extraction of the nosecone and retained distal balloon fragment without vascular injury, contralateral large-bore access, or surgical conversion, with clinical and echocardiographic assessment up to 6-week follow-up.safety

Demonstrates a stepwise, single-access percutaneous snare technique to safely retrieve a ruptured and retained TAVI balloon fragment via the existing ipsilateral sheath after correcting sheath tip deformation, avoiding surgical conversion or contralateral large-bore access.

Limitations

Single-patient case report
Requires favorable anatomical and positional conditions (nosecone near distal sheath tip and hemodynamic stability)
No definitive confirmation of the exact cause of balloon rupture
Single-patient case report with no comparator
No definitive confirmation of the mechanism causing balloon rupture
Technique applicability depends on favorable anatomical and positional conditions and hemodynamic stability

Implication

May facilitate percutaneous bailout in rare TAVI balloon rupture; leaves open prospective validation before wider adoption.

Abstract

BACKGROUND: Balloon-expandable valves are among the most commonly used platforms for transfemoral transcatheter aortic valve implantation (TAVI). Although deployment-related complications are uncommon, balloon rupture with distal fragment retention is a rare but technically demanding scenario with no standardized retrieval protocol. CASE SUMMARY: A 79-year-old patient underwent a transfemoral TAVI with a balloon-expandable valve. Balloon rupture during deployment resulted in partial retention of the distal balloon segment. The patient remained hemodynamically stable without annular or aortic injury. The retained fragment was successfully retrieved through the same femoral access site using a snare-based technique, without contralateral large-bore access or surgical conversion. DISCUSSION: Same-access snaring through the ipsilateral E-sheath-after correcting the deformed tip to restore coaxial alignment-allows safe, controlled extraction of the retained balloon fragments through a single-access site. Recognizing and correcting sheath tip deformation before snare advancement is a critical technical prerequisite. TAKE-HOME MESSAGES: Balloon rupture during balloon-expandable TAVI may result in retained balloon fragments. Same-access snaring through the ipsilateral E-sheath is a feasible and safe first-line strategy. Sheath deformation must be recognized and corrected to ensure successful extraction without escalation to additional access or surgery.

Discussion

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Cite This Study

Maaroufi et al. (2026) conducted a case report in Low-flow low-gradient aortic stenosis undergoing transfemoral balloon-expandable TAVI complicated by balloon rupture and distal fragment retention (n=1). Same-access snare-based retrieval through the ipsilateral 16-F E-sheath after sheath tip straightening with a 0.035-inch J-tip guidewire was evaluated on Successful extraction of retained distal balloon fragment and nosecone without vascular injury or surgical conversion. Same-access snaring through a straightened ipsilateral 16-F E-sheath successfully retrieved a retained ruptured TAVI balloon fragment in 1 patient without vascular injury or surgical conversion.

synapsesocial.com/papers/6a4751d25c29257aa2578bc7 https://doi.org/10.1016/j.jaccas.2026.109111

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Single-Access Retrieval of a Ruptured Balloon During Balloon-Expandable TAVI

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Single-Access Retrieval of a Ruptured Balloon During Balloon-Expandable TAVI

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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