Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2018;71:45 - Vol. 71 Num.01 DOI: 10.1016/j.rec.2017.06.015

SAPIEN 3 Embolization Due to a Leak in the Y Connector

José María Cubero Gómez a, Mónica Fernández Quero a, Sara Casquero Domínguez a,

a Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Virgen del Rocío, Sevilla, Spain

Article

An 81-year-old man with severe aortic valve stenosis (mean gradient, 45 mmHg; valve area, 0.70 cm2) was referred for percutaneous aortic valve implantation given his frailty (Society of Thoracic Surgeons Predicted Risk of Mortality score < 5%). After balloon valvuloplasty with a 23-mm catheter, an Edwards SAPIEN 3 26-mm valve was positioned on the aortic annulus. During inflation, the valve did not fully deploy (Figure 1). Reinflation was attempted without achieving the desired deployment and the valve migrated toward the ascending aorta (Figure 1). A second 26-mm Edwards SAPIEN 3 valve was successfully implanted through the migrated valve (Figure 1). This second valve was also subsequently displaced, with inversion (video of the supplementary material). It was not implanted in the transverse arch due to the risk of occlusion of the left vertebral artery (Figure 1, the asterisk marks the origin of the aorta). The Edwards SAPIEN 3 valve required traction and buddy-balloon technique (Figure 1) to cross the horizontal thoracic aorta, before descending to the celiac axis (Figure 2). In view of the risk of abdominal ischemia (inverted prosthesis, Figure 2), it was displaced and implanted in the descending thoracic aorta (Figure 2) with subsequent Cheatham Platinum (CP) 45 x 24 mm stent placement (Figure 2). Subsequent computed tomography showed that the stent was patent (Figure 2). The patient was asymptomatic 9 months later.

Figure 1.

Figure 2.

The mechanism that caused prosthesis migration in our case has not been reported previously. The leak in the Commander delivery system arose from a fissure in the inflation axis of the Y connector (Figure 2, arrow), thus not allowing full valve deployment.

CONFLICTS OF INTEREST

J.M. Cubero Gómez has received fees as a participant in talks organized by Edwards Lifesciences.

SUPPLEMENTARY MATERIAL

Video

Corresponding author: saracasquero@gmail.com

1885-5857/© 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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