Correction of a Malpositioned Portico Transcatheter Aortic Valve Using a Snare Maneuver

Ponangi, Udaya Prashant; Yadav, Sumit; Kushwaha, Virag; Yadav, Riabhan; Lander, K.; Eng, L.

doi:10.1016/j.jaccas.2019.11.023

Cited by 3 publications

(4 citation statements)

References 5 publications

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“…This technique, despite being recognized to manage several complications after TAVI, 10 is mainly used to valve repositioning after low implantation, in cases of severe paravalvular regurgitation, or to facilitate valve implantation in challenging anatomies. 13 , 14 Its use for valve retrieval after coronary occlusion is seldomly reported in medical literature, and to best of our knowledge, this is one the first case reports describing it to resolve a life-threatening coronary occlusion after TAVI.…”

Section: Discussionmentioning

confidence: 92%

Acute left main coronary occlusion after transcatheter aortic valve implantation: life-saving intervention using the snare technique—a case report

Lopes

Brito

Teles

et al. 2022

European Heart Journal - Case Reports

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Background Transcatheter aortic valve implantation (TAVI) has rapidly evolved and changed the field of structural cardiovascular intervention. Its advances lead to a marked reduction in the risk of complications and improved outcomes. However, TAVI is still associated with potential serious complications. Case summary A 73-year-old man with severe aortic stenosis underwent TAVI using a 34-mm self-expanding aortic bioprosthesis. After valve deployment, the patient rapidly progressed to cardiac arrest. Acute left main occlusion, due to high valve implantation, was promptly recognized and advanced life support immediately initiated. Concomitantly, the valve was successfully retrieved toward the ascending aorta using the snare technique, resulting in immediate restoration of flow and successful cardiopulmonary resuscitation. Subsequently, a 29-mm balloon-expandable aortic bioprosthesis was uneventfully implanted. After TAVI, the patient had a remarkable clinical evolution and was discharged home at hospitalization day 5 without relevant electrocardiographic nor echocardiographic disturbances. At 6-month follow-up, the patient remains asymptomatic and transthoracic echocardiography revealed a normofunctional aortic bioprosthesis with preserved left ventricular ejection fraction. Discussion Acute coronary occlusion is a rare and life-threating complication of TAVI that may be prevented with accurate procedure planning. Pre-procedural computed tomography angiography is essential for a comprehensive patient evaluation, allowing appropriate valve selection, a key factor for successful management. Self-expandable valve retrieval with snare technique can be an appropriate strategy for the management of this complication. This case highlights the importance of performing these procedures in highly experienced centers and with fully equipped catheterization laboratories to allow timely interventions when facing unexpected events.

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Section: Discussionmentioning

confidence: 92%

Acute left main coronary occlusion after transcatheter aortic valve implantation: life-saving intervention using the snare technique—a case report

Lopes

Brito

Teles

et al. 2022

European Heart Journal - Case Reports

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“…There have been several case reports of snaring maneuvers described in the literature. Ponangi et al reported [7] a successful use of a single snare technique for a downward dislocated Portico valve with a 25-mm Amplatzer Gooseneck Snare. However, there were no significant calcifications of the aorta present which could aggravate the repositioning procedure.…”

Section: Discussionmentioning

confidence: 99%

“…In all previous cases the single snare technique was described as technically demanding but feasible. A technique with two snares with additional right radial access has also been proposed but not used [7]. Failure of the single snare technique in our complex case of Portico valve dislocation in the LVOT led us to use a novel, double snaring technique with two snares.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Aortic Valve Dislocation in Left Ventricular Outflow Tract with Successful Repositioning Using “Double Snare” Technique

Bunc¹,

Vitez²,

Terseglav³

et al. 2021

IJCM

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Background: Transcatheter aortic valve implantation (TAVI) is a widely used treatment of severe aortic stenosis. Implantation of a self-expanding valve into a dense calcified aortic annulus can be challenging and may result in device malposition and malfunction. Aim: The aim of our case report is to present a novel technique of transcatheter aortic valve dislocation treatment. Case presentation: An 86-year-old woman with severely calcified aortic valve underwent TAVI using a 27-mm self-expanding Portico valve (Abbott Vasc, USA). In the last phase of implantation, the valve dislocated deep into the left ventricular outflow tract resulting in significant paravalvular regurgitation and patient instability. Repositioning of the valve with a single snare was ineffective because of severe aortic ring calcifications. A novel "double snare" technique was applied and the valve was successfully repositioned upward with an excellent anatomic and haemodynamic result. Conclusion: "Double snare" technique can be an effective strategy for repositioning of deeply implanted self-expanding transcatheter aortic valves. It represents an efficient bailout strategy in case of single snare approach failure, especially in cases of severe aortic ring calcifications.

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“…4 To the best of our knowledge, there are very few cases in the literature like this case. 5 Th e case presented in this paper is one of them to only use a snare to reposition the Portico self-expanding bioprosthesis. In our case, we only used the snare technique to pull back the malpositioned prosthesis without using the balloon pull technique and without implantation of the second valve.…”

Section: Case Studymentioning

confidence: 99%

Düşük Yerleşimli Bioprotez Aortik Kapak Komplikasyonunun Yakalama Tekniği ile Yönetimi

Taş¹,

Bakir

2020

Sakarya Medical Journal

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Transcatheter aortic valve implantation (TAVR) is an alternative technique that is used to treat severe aortic stenosis (AS). Dislocation and paravalvular aortic regurgitation are two of the most common technical complications associated with TAVR, and they must be addressed using endovascular treatment options or surgery. This paper presents a TAVR case report with the complication of valve dislocation that was resolved by pulling the valve back using the snare technique.

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Correction of a Malpositioned Portico Transcatheter Aortic Valve Using a Snare Maneuver

Cited by 3 publications

References 5 publications

Acute left main coronary occlusion after transcatheter aortic valve implantation: life-saving intervention using the snare technique—a case report

Acute left main coronary occlusion after transcatheter aortic valve implantation: life-saving intervention using the snare technique—a case report

Transcatheter Aortic Valve Dislocation in Left Ventricular Outflow Tract with Successful Repositioning Using “Double Snare” Technique

Düşük Yerleşimli Bioprotez Aortik Kapak Komplikasyonunun Yakalama Tekniği ile Yönetimi

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