JACC: CARDIOVASCULAR INTERVENTIONS
VOL. 9, NO. 8, 2016
ª 2016 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 1936-8798/$36.00
PUBLISHED BY ELSEVIER
http://dx.doi.org/10.1016/j.jcin.2016.01.040
IMAGES IN INTERVENTION
An Unusual Complication After Rupture
of the SAPIEN 3 Valve Balloon During
Transcatheter Aortic Valve Replacement
Fadi J. Sawaya, MD, Andrew Roy, MD, Antoinette Neylon, MD, Marco Spaziano, MD, Thomas Hovasse, MD
A
56-year-old man with a history of chest radi-
tomography
ation and severe aortic stenosis was trans-
measuring 482 cm2 with an area-derived diameter of
ferred to our institution for percutaneous
aortic valve replacement. The multislice computed
scan
showed
an
aortic
annulus
24.8 mm and prominent calcifications at the sinotubular junction (Figure 1).
An Edwards SAPIEN 3 (S3) 26-mm valve (Edwards
F I G U R E 1 Pre-Procedural Multislice Computed Tomography
Lifesciences,
Irvine,
California)
was
accordingly
implanted via a left femoral approach. However, at
the end of the valve implantation, the valve balloon
ruptured (Figure 2, Online Video 1). An aortic root
F I G U R E 2 Angiographic View of Balloon Rupture During
Valve Deployment
Multislice computed tomography scan showing calcification at
Balloon rupture at the end of valve deployment with contrast
the level of the sinotubular junction.
extravasation (Online Video 1).
From the Department of Cardiology, Générale de Santé, Institut Cardiovasculaire Paris–Sud, Hôpital Privé Jacques Cartier, Massy,
France. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Manuscript received January 7, 2016; accepted January 14, 2016.
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Sawaya et al.
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 9, NO. 8, 2016
APRIL 25, 2016:e79–81
Rupture of a SAPIEN 3 Valve Balloon
F I G U R E 3 Angiographic View of the E-Sheath
F I G U R E 5 Angiographic View of the Delivery Catheter at the
Left Common Femoral Artery
Split E-sheath as seen in angiography.
Nose cone of the commander delivery catheter stuck at the level
of the left common femoral artery.
angiogram showed adequate valve deployment with
mild paravalvular regurgitation near the left coro-
Passeo balloon (Biotronik, Berlin, Germany) was
nary cusp that was trivial by transthoracic echo-
inflated to ensure adequate hemostasis (Figure 6).
cardiography.
the
At this point, the vascular team was consulted and
commander delivery system (Edwards Lifesciences)
performed a surgical cut down with successful
through
retrieval of the Edwards delivery system, which
the
An
14-F
attempt
expandable
to
remove
sheath
(eSheath,
Edwards Lifesciences) was unsuccessful and met a
lot of resistance, which led to splitting of the sheath
(Figure 3). It was then decided to remove the sheath
and the valve balloon as 1 unit. However, the nose
cone of the commander delivery system was stuck
F I G U R E 6 Angiographic View of the Crossover Balloon
Inflation
at the common femoral level and was unable to be
retrieved (Figures 4 and 5). Given the bleeding from
the common femoral access, a crossover 9 40-mm
F I G U R E 4 Picture of E-Sheath Outside of the Body
A 9 40-mm Passeo balloon (Biotronik) inflated in the left
Split E-sheath (Edwards Lifesciences) outside of the body.
external iliac for adequate hemostasis.
Sawaya et al.
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 9, NO. 8, 2016
APRIL 25, 2016:e79–81
Rupture of a SAPIEN 3 Valve Balloon
F I G U R E 7 Pictures of the 26 mm Balloon After Surgical Retrieval
Ruptured and dismantled 26-mm valve balloon.
F I G U R E 8 Angiogram of Left Common Femoral Artery After
Surgical Repair
showed severe dismantling and tearing of the
valve balloon (Figures 7A and 7B). The final angiogram showed successful common femoral artery
closure with no complications (Figure 8, Online
Video 2).
We assumed that the balloon ruptured when it
came in contact with the calcification spicules on the
sinotubular junction. Caution should be taken when
using a balloon-expandable device in a calcified aorta
to avoid catastrophic complications from ruptured
balloons.
REPRINT REQUESTS AND CORRESPONDENCE: Dr.
Fadi J. Sawaya, Institut Cardiovasculaire Paris Sud,
56 Quai de Jemmapse, Paris, 75010 France. E-mail:
[email protected].
KEY WORDS balloon rupture, transcatheter aortic valve replacement,
SAPIEN 3
Final angiogram showing successful repair of left common
femoral artery (Online Video 2).
A PP END IX For supplemental videos, please see the online version
of this article.
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