Use of EN Snare device for successful repositioning of the newest self-expanding transcatheter heart valve

Successful Treatment of Severe Paravalvular Leak by Repositioning a Self-Expandable Percutaneous Aortic Valve Bioprosthesis (Evolut PRO+) Using the “Double Snare” Technique

Significant (moderate or severe) paravalvular leak (PVL) after transcatheter aortic valve replacement (TAVR) remains a common phenomenon and has been associated with decrease survival and quality of life. Transcatheter valve embolization and migration (TVEM) is a rare post-TAVR complication that can occur in 1% of cases and has been associated with worse patient outcomes. Valve embolization or migration into the left ventricle can result in significant PVL causing hemodynamic instability, shock, heart failure, and hemolytic anemia. Although this complication most commonly occurs in the acute setting (90%) within 4 hours of TAVR, it can also present late (4 hr-43 days later) in 10% of cases. There are no clear guidelines as to how this condition should be managed; however, several percutaneous bailout techniques exist that can ultimately spare the patient from emergent cardiovascular surgery. We present a rare case of late ventricular transcatheter aortic valve migration 3 days after TAVR causing severe PVL and heart failure symptoms that was successfully treated using the percutaneous “double snare” technique.

Correction of a Malpositioned Portico Transcatheter Aortic Valve Using a Snare Maneuver

A 75-year-old woman with severe aortic stenosis underwent transcatheter aortic valve replacement using a 23-mm self-expanding Portico valve (Abbott). After complete deployment, it was found to be unacceptably low, with significant paravalvular regurgitation. The valve was pulled upward to the correct position successfully by using the snare maneuver. (Level of Difficulty: Advanced.)