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

Abstract

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.

Successful Treatment of Severe Paravalvular Leak by Repositioning a Self-Expandable Percutaneous Aortic Valve Bioprosthesis (Evolut PRO+) Using the “Double Snare” Technique

“…This procedure is not to be confused with the snare technique used for facilitating advancement of the TAVR delivery system across challenging aortic anatomy and the aortic valve [ 9 ]. Adding a second snare as we did in this case, a maneuver known as the “double snare” technique, has also been described as a way to augment the pulling force and likelihood of successful repositioning [ 7 ]. We used the right radial approach to snare the contralateral tab of the valve at the inner aortic curve and the femoral approach to snare from the opposite side the remaining valve tab at the outer aortic curve.…”