CoreValve – ICE AwardsItalian CoreValve ExpertsBalloon valvuloplasty after Transcatheter Aortic Valve Implantation (TAVI): always safe?Dr Salvi A, Dr Fabris E, Dr Perkan ACardiovascular Department, Ospedali Riuniti and University of Trieste, Italy

• 82 year old man • Referred to our Center for a severe

symptomatic aortic stenosis • Selected by the Heart Team for TAVI

because of a high surgical risk (log. EuroSCORE 21%)

• Diameters of the aortic annulus (on computed tomographic) were 32 x 22 mm, the perimeter was 87 mm

• A 31 mm CoreValve™ prosthesis (Medtronic, Minneapolis, MN, USA) was selected

Dati Basali

Intervento

• Femoral access with a 18 Fr sheath

• Stiff guidewire was placed in the left ventricle

• Prosthesis was advanced across the stenotic valve without prior Balloon Valvuloplasty

Sheath cover retracting under fluoroscopic guidance

Intervento

The position of the CoreValve™ seemed optimal with the distal

end 5 mm below the

“angiographic” annulus

Release of the prosthesis

Difficoltà incontrate

• Good placement but compression of the distal part of the prosthesis

• Presence of significant aortic regurgitation

Soluzione sceltaBalloon valvuloplasty (BV) during rapid pacing

• We performed a BV with a Cristal Balloon 28x50 (Balt, Montmorency, France).

• The balloon was advanced across the valve and was inflated and deflated during rapid pacing

Angiography after balloon deflation:acute dislocation of the prosthesis

Immagini post-operatorie

The valve showed an appropriate

expansion but had moved upwards now with the distal

part ending apparently just

above the “angiographic”

annulus

• The valve seemed anchored without further upward movements

• The patient was stable• Systolic gradient was absent • Final angiography showed only a mild

AR• A persistent good result was

documented at follow up echo after two weeks

Conclusioni

• In our case a post implantation balloon valvuloplasty (BV) caused an acute accidental dislocation of CoreValve™ with potential risk of valve embolization

• BV after CoreValve™ implantation performed without a prior dilatation is an effective procedure but it may cause accidental movements of the prosthesis despite a meticulous technique

• This may be relevant because the strategy of performing TAVI without balloon predilatation is becoming common