From TAVR to SAVR

Background:Transcatheter aortic valve replacement (TAVR) is an established minimally invasive therapy for severe aortic stenosis, with a steadily declining incidence of procedural complications. Nevertheless, emergent conversion to surgical aortic valve replacement (SAVR), although rare, remains associated with substantial morbidity and mortality. Case Summary:A 71-year-old male with severe aortic stenosis and multiple comorbidities underwent elective transfemoral TAVR using a 26-mm SAPIEN 3 Ultra Resilia valve. Initial post-deployment imaging demonstrated satisfactory valve position and hemodynamic performance. On postoperative day 0, the patient developed severe hypertension followed by embolization of the bioprosthetic valve into the left ventricular outflow tract (LVOT), resulting in obstruction and interference with the mitral valve apparatus. Given the risk of hemodynamic collapse, the patient was taken emergently for explant of the TAVR . Intraoperative findings revealed a migrated and rotated transcatheter valve causing partial LVOT obstruction and laceration of the ventricular side of the anterior mitral valve leaflet. The valve was successfully explanted, and surgical aortic valve replacement was performed. The postoperative course was complicated by transient acute kidney injury, which resolved prior to discharge on postoperative day 9. Conclusion:This case illustrates a rare but life-threatening complication of TAVR requiring emergent surgical intervention and highlights the importance of vigilant monitoring, strict hemodynamic control, and immediate surgical readiness.