Longitudinal Deployment Balloon Rupture With Uncomplicated Retrieval During TAVR

Deployment-balloon rupture during balloon-expandable transcatheter aortic valve replacement can impede device retrieval. An octogenarian woman underwent transfemoral implantation of a 23-mm SAPIEN 3 Ultra RESILIA valve. The balloon ruptured at approximately the nominal inflation volume adjacent to focal sinotubular-junction calcification. Immediate aspiration produced complete collapse without residual contrast or abnormal balloon geometry, permitting resistance-free retrieval into the 14-F eSheath. Inspection demonstrated a longitudinal tear involving nearly the entire balloon length without circumferential separation or missing fragments. Tear orientation was identifiable only after retrieval; during the procedure, residual contrast, balloon geometry, response to aspiration, and withdrawal resistance guided management. This case suggests that rupture configuration may influence balloon collapse and retrievability, although the proposed relationship remains hypothesis-generating.