Key result
Double-snare-assisted repositioning offers a feasible percutaneous approach to manage malpositioned TAVR valves.
Why the study?
Managing malpositioned transcatheter aortic valve replacement valves lacks established percutaneous strategies for safe and effective repositioning.
Does a double-snare-assisted reimplantation strategy offer a feasible percutaneous approach for managing malpositioned TAVR valves?
Case Report
Does a double-snare-assisted reimplantation strategy offer a feasible percutaneous approach for managing malpositioned TAVR valves?
A novel double-snare-assisted repositioning technique provides a feasible percutaneous option for salvaging malpositioned TAVR valves, potentially avoiding the need for open heart surgery.
May enable bailout repositioning of malpositioned TAVR valves; hypothesis-generating and requires prospective validation before adoption.
OBJECTIVE: To highlight a novel and strategic approach to managing a malpositioned transcatheter aortic valve replacement valve using a double-snare-assisted reimplantation strategy. KEY PROCEDURAL STEPS: Key procedural steps include maintaining guidewire access through the valve, using a True Flow balloon to enhance control over valve maneuverability and repositioning, applying a crisscross double-snare technique allowing the valve to fold inward and minimize aortic trauma, carefully repositioning the valve to a desirable location in the aorta, maintaining control of the mobilized valve with a snare, and finally, properly implanting a new valve. POTENTIAL PITFALLS: Potential risks and complications of the procedure include aortic trauma, stroke, valve entanglement, and undesirable valve embolization as well as the possible need for conversion to open heart surgery. TAKE-HOME MESSAGES: The double-snare-assisted repositioning technique may offer a feasible percutaneous approach for managing malpositioned transcatheter aortic valve replacement valves. Given the increasing frequency of high-risk valve-in-valve procedures, clinicians should aim to enhance their expertise in managing these challenging complications.
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Golzarian et al. (2025) conducted a case report in Malpositioned transcatheter aortic valve replacement valve. Double-snare-assisted reimplantation strategy was evaluated. A double-snare-assisted repositioning technique may offer a feasible percutaneous approach for managing malpositioned transcatheter aortic valve replacement valves.
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