Successful delayed endovascular correction of migration of transcatheter aortic valve prosthesis in left ventricle outflow tract: case report

We report the successful endovascular correction of the migration of a transcatheter aortic valve prosthesis in the left ventricle outflow tract (LVOT). A 72-old man was underwent transcatheter aortic valve implantation (TAVI) at Almazov National Medical Research Centre for severe aortic stenosis. During the procedure, the self-expanding prosthesis dislocated 10-12 mm into the LVOT. The frame was optimised with the use of a balloon catheter, and aortic regurgitation I-II degree was achieved. However, on day 17 of hospitalisation, acute heart failure with episodes of asystole occurred as a result of severe paravalvular regurgitation; cardiopulmonary resuscitation was necessary. The prosthesis malpositioning was corrected by traction with endovascular snare devices. The patient was stable during the postprocedural period and discharged on day 31. Dislocation of self-expanding prostheses into the LVOT is a complication specific to TAVI that may quickly aggravate a patient's condition; therefore, correction of valve malpositioning should be performed as soon as possible. The case reported here in an illustration of successful endovascular correction of dislocation performed with the snare traction technique. This bail-out approach can be used by interventional cardiologists in similar situations.