From TAVR to SAVR

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Mixed aortic valve disease (severe aortic stenosis and moderate-to-severe aortic regurgitation) complicated by delayed transcatheter valve embolization (n=1). Intervention: Emergent surgical explant of embolized 26-mm SAPIEN 3 Ultra Resilia TAVR valve, mitral leaflet repair, and conversion to SAVR (27-mm Edwards Inspiris). Primary outcome: Successful surgical rescue, valve hemodynamic performance, and patient recovery.

Q: What does this research mean for the field?

Emergent surgical explantation and conversion to SAVR can successfully rescue delayed transcatheter aortic valve embolization into the left ventricular outflow tract complicated by mitral leaflet injury. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Karen Hovsepyan; Amy Hutchinson; Michael Finamore; Lucas Henn

doi:10.46570/utjms-2026-2016

October 28, 2026Translation The University of Toledo Journal of Medical SciencesOpen Access

From TAVR to SAVR

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Key result

Emergent surgical explant and SAVR successfully rescues delayed ventricular TAVR embolization.

n=1

Why the study?

Although procedural complications during TAVR for severe aortic stenosis have steadily declined, rare emergent conversion to SAVR remains associated with substantial morbidity and mortality.

Key Points

To report a case of delayed transcatheter aortic valve migration into the left ventricular outflow tract causing structural cardiac damage and requiring emergent open surgical conversion.
A 71-year-old male with mixed aortic valve disease and an annular area of 563 mm² underwent elective transfemoral TAVR using a 26-mm SAPIEN 3 Ultra Resilia valve deployed with nominal plus 2 mL balloon volume.
Following postoperative hypertension, valve embolization was identified on echocardiography, prompting immediate conversion to emergent open cardiac surgery.
Intraoperative direct inspection demonstrated that the transcatheter valve had rotated 90 degrees into the left ventricular outflow tract, partially obstructing flow and lacerating the ventricular surface of the anterior mitral valve leaflet.
The transcatheter prosthesis was successfully explanted and replaced with a surgical aortic valve; transient acute kidney injury resolved prior to patient discharge on postoperative day 9.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 71-year-old male with mixed severe aortic stenosis and moderate-to-severe aortic regurgitation who underwent elective transfemoral TAVR and was followed for 30 days after emergent surgical conversion.

I

Intervention

Elective transfemoral transcatheter aortic valve replacement (TAVR) using a 26-mm SAPIEN 3 Ultra Resilia valve (deployed with nominal plus 2 mL balloon volume at 80% aortic/20% ventricular depth), followed by emergent surgical explantation on postoperative day 1, surgical aortic valve replacement (SAVR) with a 27-mm Edwards Inspiris bioprosthetic valve, anterior mitral leaflet repair with a 5-0 polypropylene figure-of-eight suture, and concomitant biatrial cryoablation and bipolar MAZE procedure with left atrial appendage exclusion

O

Outcome

Successful surgical rescue, valve explantation, mitral valve repair, and patient survival to hospital discharge on postoperative day 9 and 30-day follow-uphard clinical

This case report highlights that delayed transcatheter aortic valve embolization into the LVOT can cause secondary mechanical laceration of the anterior mitral leaflet even without immediate hemodynamic collapse, underscoring the need for routine post-procedural imaging and immediate cardiac surgical backup.

Limitations

Single-patient case report cannot establish a definitive causal mechanism for the valve embolization
Available medical records did not document the specific rationale for selecting a 26-mm rather than a 29-mm valve
Cannot retrospectively establish whether a larger transcatheter prosthesis or initial SAVR would have prevented migration or produced a superior outcome
Cannot establish a causal relationship between the timing of surgical intervention and the extent of mitral leaflet injury
The medical record available for this report does not document the specific rationale for selecting a 26-mm rather than a 29-mm valve, so the authors cannot retrospectively establish whether use of a larger prosthesis would have prevented migration.
It cannot be determined from this single case whether initial SAVR would necessarily have produced a superior outcome.
The present case cannot establish a causal relationship between timing of intervention and the extent of leaflet injury, nor can the specific mechanism of embolization be definitively established.

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Implication

Severe post-TAVR hypertension may signal delayed LVOT embolization risk; this case leaves open incidence and prevention strategies.

Abstract

Background:Transcatheter aortic valve replacement (TAVR) is an established minimally invasive therapy for severe aortic stenosis, with a steadily declining incidence of procedural complications. Nevertheless, emergent conversion to surgical aortic valve replacement (SAVR), although rare, remains associated with substantial morbidity and mortality. Case Summary:A 71-year-old male with severe aortic stenosis and multiple comorbidities underwent elective transfemoral TAVR using a 26-mm SAPIEN 3 Ultra Resilia valve. Initial post-deployment imaging demonstrated satisfactory valve position and hemodynamic performance. On postoperative day 0, the patient developed severe hypertension followed by embolization of the bioprosthetic valve into the left ventricular outflow tract (LVOT), resulting in obstruction and interference with the mitral valve apparatus. Given the risk of hemodynamic collapse, the patient was taken emergently for explant of the TAVR . Intraoperative findings revealed a migrated and rotated transcatheter valve causing partial LVOT obstruction and laceration of the ventricular side of the anterior mitral valve leaflet. The valve was successfully explanted, and surgical aortic valve replacement was performed. The postoperative course was complicated by transient acute kidney injury, which resolved prior to discharge on postoperative day 9. Conclusion:This case illustrates a rare but life-threatening complication of TAVR requiring emergent surgical intervention and highlights the importance of vigilant monitoring, strict hemodynamic control, and immediate surgical readiness.

Discussion

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Cite This Study

Hovsepyan et al. (2026) conducted a case report in Mixed aortic valve disease (severe aortic stenosis and moderate-to-severe aortic regurgitation) complicated by delayed transcatheter valve embolization (n=1). Emergent surgical explant of embolized 26-mm SAPIEN 3 Ultra Resilia TAVR valve, mitral leaflet repair, and conversion to SAVR (27-mm Edwards Inspiris) was evaluated on Successful surgical rescue, valve hemodynamic performance, and patient recovery. Emergent surgical explant and SAVR with a 27-mm bioprosthetic valve successfully rescued a 71-year-old male after delayed LVOT TAVR embolization, resulting in discharge on postoperative day 9.

synapsesocial.com/papers/6ae433d2d9418cd7c8f46f37 https://doi.org/10.46570/utjms-2026-2016

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From TAVR to SAVR

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

From TAVR to SAVR

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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