Key result
Transapical valve replacement with wire-loop repositioning successfully restores coronary flow after sutureless valve migration.
Why the study?
Sutureless aortic prosthesis migration is rare but potentially catastrophic, and repositioning after surgical excision of the native leaflets causes severe aortic regurgitation.
Case Report (n=1)
Prepositioned transapical transcatheter valve replacement combined with transfemoral wire-loop repositioning is a viable bailout strategy for cranial migration of a sutureless aortic prosthesis.
Answers are grounded in this paper and cite their sources.
Supports intraoperative imaging for suspected sutureless valve migration; leaves open optimal bailout strategies.
BACKGROUND: Sutureless aortic prosthesis migration is rare but potentially catastrophic. CASE SUMMARY: A 78-year-old woman on hemodialysis underwent minimally invasive double valve replacement using a sutureless aortic bioprosthesis. Failure to wean from cardiopulmonary bypass prompted intraoperative angiography, which raised suspicion of cranial migration of the aortic prosthesis, with bilateral coronary hypoperfusion; subsequent computed tomography confirmed the diagnosis. Because repositioning after surgical excision of the native leaflets would cause severe aortic regurgitation, a transapical transcatheter valve was prepositioned before transfemoral wire-loop repositioning. Coronary flow was restored, the failed valve was replaced, and 5-month follow-up showed preserved ventricular function and stable frame position. DISCUSSION: Prepositioning a transapical transcatheter valve before wire-loop repositioning enabled immediate valve replacement while minimizing the empty-annulus interval. TAKE-HOME MESSAGE: Failed passage of a Perceval sizer should preclude sutureless implantation; prepositioned transapical valve replacement with wire-loop repositioning is a viable bailout.
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Hamada et al. (2026) conducted a case report in Migrated sutureless aortic bioprosthesis with bilateral coronary hypoperfusion (n=1). Prepositioned transapical transcatheter valve replacement with transfemoral wire-loop repositioning was evaluated on Restoration of coronary flow, valve replacement, ventricular function, and frame position. Prepositioned transapical valve replacement with wire-loop repositioning restored coronary flow in a 78-year-old woman with a migrated sutureless valve, with stable function at 5 months.
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