Case Review of a TAVI Migration to the Left Ventricle

Proper management of uncommon transcatheter aortic valve implantation (TAVI) complications, such as retrograde embolization to the left ventricle, gained particular importance as their incidencec continued to increase. The authors describe a high-risk patient in whom a #25 ACURATE neo2 valve migrated almost completely to her left ventricle during implantation due to a deployment anomaly. She promptly required emergent removal of the prothesis and surgical aortic valve replacement while the delivery mechanism was still in place. The prothesis was entertained with the mitral valve cords; however, careful collapse of the migrated valve allowed for its removal and a favorable outcome. The presence of a heart team for discussion and prompt response to this dangerous complication allowed for a good outcome in this particular patient, highlighting its importance. 

References

1. Kim, W. K., Schäfer, U., Tchetche, D., Nef, H., Arnold, M., Avanzas, P., Rudolph, T., Scholtz, S., Barbanti, M., Kempfert, J., Mangieri, A., Lauten, A., Frerker, C., Yoon, S. H., Holzamer, A., Praz, F., De Backer, O., Toggweiler, S., Blumenstein, J., Purita, P., … Hamm, C. W. (2019). Incidence and outcome of peri-procedural transcatheter heart valve embolization and migration: the TRAVEL registry (TranscatheteR HeArt Valve EmboLization and Migration). European heart journal, 40(38), 3156–3165. https://doi.org/10.1093/eurheartj/ehz429

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