A word of caution using self‐expanding transcatheter aortic valve‐frame infolding

• Published in: Catheterization and cardiovascular interventions Vol. 93; no. 3; pp. 555 - 558
• Main Authors: Ben‐Dor, Itsik, Rogers, Toby, Satler, Lowell F., Waksman, Ron
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 15.02.2019; Wiley Subscription Services, Inc
• Subjects: Aged; Alloys; Aortic stenosis; Aortic valve; Aortic Valve - diagnostic imaging; Aortic Valve - physiopathology; Aortic Valve - surgery; Aortic Valve Insufficiency - diagnostic imaging; Aortic Valve Insufficiency - etiology; Aortic Valve Insufficiency - physiopathology; Aortic Valve Insufficiency - therapy; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Balloon Valvuloplasty; complication; Electrocardiography; Female; Heart Valve Prosthesis; Hemodynamics; Humans; Nickel titanides; Prosthesis Design; Prosthesis Failure; Recovery of Function; self‐expanding valve; Severity of Illness Index; Stenosis; Surgeons; transcatheter aortic valve; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - instrumentation; Treatment Outcome; transcatheter aortic valve; complication; self-expanding valve
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.27870

Transcatheter aortic valve replacement has become a mainstay alternative to surgical aortic valve replacement in patients with severe aortic stenosis at high and intermediate surgical risk. Two commercially approved valves are available in the United States: balloon‐expandable and self‐expanding. We report here a rare complication of a self‐expanding Evolut PRO (Medtronic, Minneapolis, Minnesota) valve failing to expand due to nitinol frame infolding. This results in a malopposed valve with a severe paravalvular leak, even though treated successfully with balloon valvuloplasty. It is important to recognize the characteristic angiographic signature of this complication—the “straight line” sign—and how to avoid this potentially serious complication by balloon valvuloplasty or by recapture and deployment of a new valve.