Successful Bailout via Brachiocephalic Artery Incision for Balloon Rupture during Trans-Subclavian Aortic Valve Implantation

Abstract

Objective: Balloon rupture during transcatheter aortic valve implantation (TAVI) can be a challenging complication to manage, especially with alternative access routes. We report a case of a successful bailout after a balloon rupture during trans-subclavian TAVI.

Case Presentation: An 83-year-old woman was scheduled to receive TAVI. Peripheral access was poor, so we planned for a trans-subclavian approach. The patient has low left ventricular function, and an arterial cannula for percutaneous cardio-pulmonary support was inserted from the left subclavian artery (SCA), and then, it was decided to perform TAVI through the right SCA. However, during the valve alignment process, the axis of the sheath and the axis of the valve did not align properly, and the balloon ruptured, making both deployment and retrieval impossible. Under median sternotomy, we successfully retrieved the valve under a simple clamp of the brachiocephalic artery. Trans-aortic TAVI was followed successfully and the patient is still in good condition.

Conclusion: Balloon rupture during TAVI via trans-subclavian access can be successfully managed. This case highlights the importance of having bailout strategies for complications during TAVI procedures.