Infolding of a self-expanding bioprosthesis due to loss of nitinol memory during transcatheter aortic valve implantation

Self‐expanding transcatheter aortic valve infolding: Current evidence, diagnosis, and management

“…In patients treated with second generation self‐expanding aortic valves, infolding has been mainly observed after in situ valve resheathing and second deployment of larger Evolut R devices (29‐mm and 34‐mm) 7‐15 . Therefore, it should be suspected in any case of hemodynamic collapse after valve deployment.…”

“…More recently, it has been observed also with larger size (29‐mm and 34‐mm) second generation Evolut R and Evolut PRO, especially after in situ valve recapturing and redeployment and in heavily calcified aortic valves. Infolding can cause severe paravalvular leak (PVL) and hemodynamic collapse and it has been associated with increased risk of peri‐procedural stroke 7‐15 . However, data regarding this complication are limited as current evidence derives from isolated clinical experiences.…”

Additional balloon aortic valvuloplasty to overcome the difficult removal of a self‐expandable transcatheter aortic valve system due to valve infolding

“…Transcatheter aortic valve replacement (TAVR) is a well‐established routine, low‐risk treatment for severe aortic stenosis owing to the dramatic advances in the TAVR technology and improvements in the operators' skills, which have reduced the frequency of TAVR complications 1 . However, there have been reports of valve infolding in self‐expanding prostheses as a rare but serious outcome 2,3 . In general, the majority of adverse procedural outcomes involve hemodynamic collapses in association with severe paravalvular leak (PVL) and valve dysfunction, 4 and to the best of our knowledge, there have been no reports of cases regarding difficulties in the removal of devices due to valve infolding.…”

“…1 However, there have been reports of valve infolding in self-expanding prostheses as a rare but serious outcome. 2,3 In general, the majority of adverse procedural outcomes involve hemodynamic collapses in association with severe paravalvular leak (PVL) and valve dysfunction, 4 and to the best of our knowledge, there have been no reports of cases regarding difficulties in the removal of devices due to valve infolding. In this report, we describe a case of valve infolding that caused difficulties in catheter removal, but ultimately for which bailout could be performed successfully.…”