title: How should I treat dislocation of a TAVI SAPIEN prosthesis into the left ventricle?
abstract: BACKGROUND
  Despite the technical advancements of the transcatheter aortic valve implantation (TAVI) procedure, valve embolisation into the left ventricle remains a challenging situation requiring expedited management through the Heart Team.
  
  
  METHODS
  The advantages and pitfalls of an interventional transfemoral approach, a transapical extraction of the dislocated prosthesis or the conversion to open heart surgery have to be balanced depending on the overall situation and the specific characteristics of the patient.
  
  
  METHODS
  A transfemoral approach would be the first choice for most TAVI implanters. We discuss the different options and present an elegant solution solving this challenging situation, leading to a good immediate and long-term outcome.
  
  
  RESULTS
  Attempts at pulling the prosthesis out of the ventricle using a balloon remained unsuccessful. After grasping of the prosthesis with a goose-neck snare, the valve was pulled into the annulus. A second SAPIEN XT prosthesis was implanted and fixed the first prosthesis within the annulus. After post-dilatation, there was a good result without relevant gradient and minimal aortic regurgitation.
authors.affiliation: Department of Cardiology, HELIOS Klinikum Wuppertal, Witten/Herdecke University, Wuppertal, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Tiroch
authors.forename: Heinrich
authors.initials: H
authors.lastname: Schleiting
authors.forename: Nikos
authors.initials: N
authors.lastname: Karpettas
authors.forename: Edgar
authors.initials: E
authors.lastname: Schmitz
authors.forename: Herbert O
authors.initials: HO
authors.lastname: Vetter
authors.forename: Melchior
authors.initials: M
authors.lastname: Seyfarth
authors.forename: Marc
authors.initials: M
authors.lastname: Vorpahl
authors.forename: Martyn
authors.initials: M
authors.lastname: Thomas
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Wahab
authors.forename: Holger
authors.initials: H
authors.lastname: Sier
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D007431:Intraoperative Complications; D011475:Prosthesis Failure; D065467:Transcatheter Aortic Valve Replacement