Rescuing a Popped-Up Prosthesis

OBJECTIVE: We report the successful management of a 30-mm Hydra self-expanding tall-frame transcatheter heart valve (THV) pop-up through a redo TAVI procedure. KEY STEPS: A new Safari extra-stiff guidewire was advanced externally in respect of a 30-mm Hydra valve frame. A 25-mm Amplatz Goose Neck snare was manipulated to engage the proximal arches of the Hydra THV. In parallel, a 12 × 40 mm Atlas Gold high-pressure balloon was positioned between the Hydra valve frame and ascending aorta, and was then inflated while a new Edwards Sapien 3 Ultra 23-mm valve was advanced and eventually successfully deployed. POTENTIAL PITFALLS: Although index THV pop-up was favored by pacing loss of capture during balloon postdilation, the lack of an external sealing skirt in the Hydra THV system may have increased its susceptibility to migration during balloon maneuver, as occurred in our case. TAKE-HOME MESSAGE: To our knowledge, this is the first reported case describing the use of this combined technique to address embolization of a self-expanding tall-frame THV, resulting in an effective and safer procedure.