Bailout procedure after inadvertent false release of a self-expandable TAVI prosthesis Interventional valve-under-valve implantation

We present a case of false deployment of a self-expandable transcatheter aortic valve implantation (TAVI) prosthesis due to inadvertent and incorrect release of an eyelet in the crown of the valve resulting in a tilted valve. Hence the prosthesis had to be deployed in an anatomically and functionally inappropriate position above the coronary ostia at the level of the sinotubular junction. Because of previous coronary artery bypass grafting with patent grafts, conventional re-do surgery as bailout was rejected and implantation of a second, balloon-expandable TAVI prostheses favoured instead. This caused a valveunder-valve situation. Because of the patent bypass grafts, myocardial ischa emia could be prevented, although diastolic myocardial perfusion via native coronaries was restrict ed in this unique setting. The postoperative course was uneventful. The gradient over the valves was 12 mm Hg with minimal paravalvular leakage. At 1-year follow-up, the patient was in good clinical condition. Transthoracic echocardiography revealed a peak/ mean gradient of 16/8 mm Hg with grade 1 paravalvular leakage.