Transcatheter Aortic Valve Migration and Embolization During Transcatheter Aortic Valve Replacement: A Contemporary Management Review With a Practical Bailout Algorithm

Transcatheter aortic valve replacement has become an established therapy for severe aortic stenosis across the surgical-risk spectrum. Although procedural safety has improved, transcatheter valve embolization or migration remains an uncommon but high-impact complication that may require immediate rescue under conditions of severe acute aortic regurgitation, hemodynamic instability, coronary compromise, or branch-vessel risk. Existing evidence is derived primarily from registries, observational cohorts, technical reviews, systematic reviews, and case-based reports rather than prospective comparative trials. Building on prior descriptions of device-embolization mechanisms and location-based management, this review synthesizes contemporary evidence into an operator-oriented phenotype-based framework. We classify transcatheter valve embolization or migration into left ventricular/left ventricular outflow tract migration, annular malposition with instability, ascending aortic embolization, distal aortic embolization, and delayed migration, while emphasizing that these phenotypes may overlap or evolve during the procedure. For each phenotype, we summarize reported mechanisms, platform-specific considerations, hemodynamic hazards, and commonly described bailout strategies. Because comparative data are lacking, the proposed framework should be interpreted as an evidence-informed practical decision aid rather than recommendation-level guidance. Standardized reporting and contemporary multicenter data are needed to refine risk prediction, define procedural success, and validate phenotype-specific rescue pathways.