Recommended Citation
Hussein M, Radaideh Q, Bajwa T. TAVI for pure aortic valve insufficiency: What to expect? Poster presentation at ACC Conference; March 2026; New Orleans, LA.
Presentation Notes
Poster presentation at ACC Conference; March 2026; New Orleans, LA.
Abstract
Background: Lack of US-approved devices kept transcatheter aortic valve implantation (TAVI) for aortic insufficiency (AI) an area of unmet need. We present pure AI case managed with current TAVI devices.
Case: 90-year-old man with severe noncalcified trileaflet regurgitant aortic valve, dilated aortic root (4.1 cm), and hypokinetic left ventricle (LV), was deemed TAVI candidate and high surgical risk. SAPIEN Ultra Resilia 29mm valve +8 cc was deployed under pacing. Before femoral access site closure with pre-Perclose, we noted central AI jet on echo. Angiogram showed LV valve migration. We swiftly reinserted the 16-Fr sheath we just pulled. We deployed a valve-in-valve (ViV) 29mm SAPIEN in more aortic position and ballooned the overlap segment using 1st valve as anchor. Access site hemostasis was not achieved despite using up to four Perclose devices, and the blood pressure dropped. Ipsilateral common iliac artery perforation was noted and treated with covered stent. Covering the arteriotomy site with another stent using up-and-over technique secured hemostasis. He was discharged in 2 days.
Decision-Making: Lack of surgical options made deploying a 2nd ViV the bailout strategy of choice for our valve migration. Caution is needed in such scenarios to avoid dislodging the 1st valve and to confirm central wire position across the valve to deliver the 2nd appropriately.
Conclusion: Until AI percutaneous devices are available, the challenges we faced are expected in similar scenarios, and care should be taken.
Type
Poster
Affiliations
Aurora Sinai/Aurora St. Luke's Medical Centers