Percutaneous Mechanical Aspiration for Obstructive Mechanical Aortic Valve Thrombosis: A Bailout Strategy

Background Mechanical prosthetic valve thrombosis can be life-threatening when thrombolysis is contraindicated and redo surgery carries prohibitive risk. Case Summary A 76-year-old man with a single tilting-disc mechanical aortic valve presented with intracranial hemorrhage requiring anticoagulation reversal. Despite subsequent resumption of therapeutic anticoagulation, serial echocardiogram demonstrated progressive prosthetic thrombosis and disc restriction. With fibrinolysis contraindicated and surgery considered prohibitive, the Heart Team selected percutaneous mechanical aspiration. A 16-Fr computer-assisted vacuum thrombectomy system was advanced across the prosthesis under continuous echocardiographic and fluoroscopic guidance with cerebral embolic protection. Aspiration combined with controlled catheter–disc interaction restored disc mobility without prosthetic damage or embolic complications. Discussion This case illustrates the technical feasibility of percutaneous aspiration of a single tilting-disc mechanical aortic valve as an exceptional bailout option in carefully selected patients. Take Home Messages Percutaneous mechanical aspiration may represent a bailout strategy for highly selected patients without conventional therapeutic options.