Simple bailout technique using a snare catheter for wire withdrawal during balloon-expandable transcatheter aortic valve implantation: a case report.

Background: In transcatheter aortic valve implantation (TAVI) using a SAPIEN3 balloon-expandable valve (S3), wire withdrawal from the left ventricle (LV) during the procedure before deployment can induce vascular injury in the access site or require surgical treatment when an S3 removal is attempted. We present a successful case of bailout from this situation safely with a minimally invasive technique using a 6-F snare catheter (SC).

Case Summary: An 86-year-old woman with severe aortic stenosis underwent trans-femoral TAVI using an S3 under conscious sedation. After a pre-shaped wire was inserted into the LV from the right femoral artery, the LV wire was accidentally withdrawn completely from the LV before deployment. Wire re-insertion using a soft straight wire through the tip lumen of the S3 was hindered because the wire orientation was uncontrollable. Hence, we used a 6-F SC to control the wire direction by changing the orientation of the S3. Catching the tip of the S3 with an SC at the ascending aorta enabled us to control the wire direction, and wire re-insertion in the LV with the soft wire was successful. Furthermore, the SC worked well in advancing the S3 through the aortic valve to enhance co-axiality without aortic root injury. The S3 was successfully advanced through the aortic valve and implanted at an optimal position without complications.

Discussion: Our simple technique using a 6-F SC is technically effective, feasible, and minimally invasive and can be an option for bailout from accidental LV wire withdrawal during balloon-expandable valve TAVI.