Balloon Rupture During Balloon-Expandable TAVR: Insights Into the Role of Calcium Distribution and Lesion Preparation From Two Cases.

Balloon rupture during balloon-expandable transcatheter aortic valve replacement is a rare but potentially catastrophic complication, often driven by an underlying anatomic substrate. We present 2 cases demonstrating how calcium distribution and timing of rupture relative to valve expansion determine outcome. Late rupture after near-complete expansion resulted in no hemodynamic consequence, whereas early rupture in the setting of dense intravalvular calcification caused incomplete expansion, severe aortic regurgitation, ventricular fibrillation, repeat balloon failure, and fatal stroke. These cases highlight the importance of calcium assessment, lesion preparation, and anatomy-tailored procedural planning.