Case Report: Sapien 3 Transcatheter Heart Valve Embolization: Cause, Management, and Redo

Figures

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  Figure 1. Sapien 3 THV Embolization. Failure of rapid pacing caused Sapien 3 embolization.

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  Figure 2. Repositioning of the Embolized Sapien 3 THV. (A) Inflation of the deploying balloon to pull the whole system back. (B) Compression of the Sapien 3 THV by inflating a “buddy balloon.” (C) Anchoring of the embolized Sapien 3 THV into the descending aorta.

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  Figure 3. Post-implantation evaluation. (A) Aortic root angiography for the evaluation of the second Sapien 3 THV. (B) Descending aorta angiography for the evaluation of the anchored Sapien 3 THV. (C) Aortic arch angiography for the exclusion of any occlusion of the main arteries.

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  Figure 4. Mechanism of BEV embolization and prevention. BEV can migrate toward ascending aorta (systole pressure caused by rapid pacing failure) or left ventricle (diastole pressure). Adequate assessment of rapid pacing before implantation with V00 mode and fixed apex position and sufficient anchor with the “flare the outflow” technique could enhance the anchor of BEV. BEV, balloon expandable valve.

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  Figure 5. Management of Sapien 3 THV Embolization. Schematic illustration of the management of a Sapien 3 THV embolization. First, repositioning and anchoring of the embolized Sapien 3 THV into the descending aorta with minimally invasive approaches are performed. Second, implantation of the second Sapien 3 THV with maximal centralization of the delivery system when crossing the embolized Sapien 3 THV. Third, angiography of the aortic root, the aortic arch, and the descending aorta is performed to evaluate THV function, patency of the brachiocephalic arteries, and the stability of the embolized valve in the descending aorta.