Retrieval of a stuck transcatheter aortic valve device via left ventricular apex and transapical implantation

A 71-year-old male with schizophrenia and chronic subdural haematoma was transferred to our hospital in cardiogenic shock. Cardiopulmonary resuscitation combined with extracorporeal membrane oxygenation (ECMO) and an intra-aortic balloon pump (IABP) was initiated via the bifemoral artery and vein, leading to return of spontaneous circulation. Transthoracic echocardiography showed a severely stenotic, calcified aortic valve with an area of 0.6 cm2 and a mean pressure gradient of 23 mmHg. The stroke volume index was 18.5 mL/m2 and the left ventricular (LV) ejection fraction was 20%. Computed tomography confirmed severe calcification (calcium score of 3,310 Agatston units), consistent with low-flow, low-gradient severe aortic stenosis.

Given the patient’s comorbidities and haemodynamic instability, the Heart Team opted for urgent transcatheter aortic valve implantation (TAVI) using a 26 mm SAPIEN 3 valve (Edwards Lifesciences). Left subclavian access was chosen because both femoral arteries were occupied by ECMO and IABP devices. With a vessel diameter of >6 mm, aortic arch angle of 120°, and ascending aorta length of 74 mm, the left subclavian route was deemed feasible (Figure 1A). An 18 Fr sheath was inserted...