Paraplegia after implantation of a transcatheter aortic valve

A 78-year-old male presented with severe symptomatic aortic stenosis. The Heart Team decided to perform a transfemoral transcatheter aortic valve implantation (TAVI) with a 24.5 mm balloon-expandable Myval Octacor prosthesis (Meril Life Sciences)1.

The TAVI procedure was performed in the early afternoon, between 12:40 pm and 1:25 pm. The patient was on permanent treatment with aspirin 100 mg/od and received unfractionated heparin during the procedure, which was controlled by activated clotting time measurement. During the implantation, the valve dislodged into the ascending aorta. Retrieval with a balloon into the descending aorta was not successful (Figure 1A) and a second 24.5 mm balloon-expandable Myval Octacor prosthesis was successfully implanted (Figure 1B). After withdrawal of the guidewire, spontaneous migration of the first valve into the descending aorta was seen. Due to the stable position of the dislodged valve (Figure 1C), the procedure was terminated, and the patient was transferred to an intermediate care unit, without any suspicious clinical signs. Palpable femoral pulses were documented during the late afternoon, and the patient received standard thromboembolic protection by...