Combs, William, MD

Cox, David A, MD

Kleaveland, J Patrick, MD

Nair, Sanjeev, MD

Nawaz, Yassir, MD

Patel, Nainesh C, MD

Singer, Raymond L, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of MedicineAn Uncommon Complication During Trans-Aortic Valve ReplacementSanjeev Nair MDLehigh Valley Health Network, sanjeev.nair@lvhn.orgYassir Nawaz MDLehigh Valley Health Network, Yassir.Nawaz@lvhn.orgNainesh C. Patel MDLehigh Valley Health Network, nainesh_c.patel@lvhn.orgDavid A. Cox MDLehigh Valley Health Network, David.Cox@lvhn.orgWilliam Combs MDLehigh Valley Health Network, William.Combs@lvhn.orgSee next page for additional authorsFollow this and additional works at: http://scholarlyworks.lvhn.org/medicinePart of the Cardiology Commons, Medical Sciences Commons, and the Surgery CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtNair, S., Nawaz, Y., Patel, N., Cox, D., Combs, W., Singer, R., & Kleaveland, P. (2014, June 23-27). An uncommon complication duringtrans-aortic valve replacement. Poster presented at: The 10th annual Complex Cardiovascular Catheter Therapeutics: AdvancedEndovascular and Coronary Intervention Global Summit, Orlando, FL.AuthorsSanjeev Nair MD, Yassir Nawaz MD, Nainesh C. Patel MD, David A. Cox MD, William Combs MD, RaymondL. Singer MD, and J Patrick Kleaveland MDThis poster is available at LVHN Scholarly Works: http://scholarlyworks.lvhn.org/medicine/475Division of Cardiology, Lehigh Valley Health Network, Allentown, PennsylvaniaSanjeev U. Nair, MBBS, MD, FACP; Yassir Nawaz, MD; Nainesh C. Patel, MD, FACC; David A. Cox, MD, FACC; William Combs, MD, FACC;Raymond Singer, MD; Patrick Kleaveland, MD, FACCBACKGROUND•	Trans-aortic valve replacement (TAVR) is an alternative method of therapy for severe aortic stenosis in patients who are deemed at high risk for conventional aortic valve replacement. •	However, although minimally invasive, TAVR procedure is not free of complications.An Uncommon Complication During Trans-Aortic Valve Replacement© 2014 Lehigh Valley Health NetworkOBJECTIVE•	We report a case of aortic embolization of the TAVR valve successfully managed by capture and deployment of the embolized valve in the descending aorta. CASE REPORT•	85 year old male with history of coronary artery disease status post-PCI and severe aortic stenosis underwent TAVR via the femoral arterial approach with rapid cardiac pacing performed at the time of implantation.•	Initial balloon aortic valvuloplasty with a 23 mm balloon was performed. Thereafter a 26 mm Edwards-Sapien bio- prosthetic aortic valve was brought into place at the aortic annulus for placement (Figures	1	&	2).  •	During the placement procedure, the valve embolized into the ascending aorta (Figure	3) when a fusion beat occurred (increase in pulse pressure) (Figure	4) in the midst of rapid cardiac pacing. DISCUSSION•	Published incidence of TAVR valve embolization ranges from 0.5% to 8%.•	Common causes for TAVR valve embolization during implantation are:	 	 -	Placing	the	valve	too	aortic.	 	 -		Replacement	valve	not	co-axial	to	valve	plane.	 	 -		Loss	of	capture	during	pacing.	 	 -		Inadequate	reduction	in	pulse	pressure	during	pacing.	 	 -		Premature	termination	of	pacing.CONCLUSIONS•	Although minimally invasive, the TAVR procedure can have complications, some of which are devastating. •	However, with diligent management many of these can be avoided or mitigated.CASE REPORT (Continued)•	The embolized valve was captured, pulled back and deployed in the descending aorta using balloon inflation (Figure	5).		•	Thereafter a second 26 mm Edwards-Sapien bio-prosthetic aortic valve was inserted via the initial fully deployed TAVR valve and successfully placed at the aortic annulus (Figure	6).  Figure 1 Figure 2Figure 3 Figure 4Figure 5 Figure 6Level of aortic annulusIMAGING* Increase in  pulse pressure

An Uncommon Complication During Trans-Aortic Valve Replacement

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1476&context=medicine

An Uncommon Complication During Trans-Aortic Valve Replacement

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