Aortic Valve Leaflet Avulsion After Transcatheter Aortic Valvuloplasty: A Case Series and Literature Review.

BACKGROUND

Aortic valve leaflet avulsion (AVLA) is recognized as a life-threatening adverse event that significantly affects patient hemodynamics, often leading to additional intervention.

CASE SUMMARY: We report 2 cases from our institution of AVLA after transcatheter aortic valve replacement (TAVR). The patients had a highly mobile mass on the aortic annulus and the left ventricular outflow tract, respectively.

DISCUSSION: In both cases, a multidisciplinary team discussion resulted in the decision to monitor the patients for 48 hours for neurovascular changes while on therapeutic anticoagulation, and both patients were discharged on anticoagulants and low-dose aspirin. Their hospital courses were uneventful, and normally functional aortic valve bioprostheses were noted on follow-up.

BEYOND THE GUIDELINES: The literature on AVLA after TAVR remains limited. The current treatment approaches for AVLA are primarily invasive, including surgical repair of the valve or snaring of avulsed structures.

TAKE-HOME MESSAGE: Conservative management may be appropriate in post-TAVR AVLA cases without ischemic or embolic manifestation.