Buckling Under Pressure: Evolut FX Delivery System Malfunction and Failure to Recapture During TAVR.

OBJECTIVE

We present a case of transcatheter aortic valve replacement in a 70-year-old woman with severe bicuspid aortic valve stenosis complicated by incomplete recapture of the Evolut valve and buckling of the delivery system.

KEY STEPS: Our key steps included the following: 1) unsuccessful withdrawal of the buckled delivery system and valve into the inline sheath; 2) transradial snaring of the delivery system, followed by traction from both ends to reduce the amount of buckling; and 3) once elongated as much as possible, the malfunctioning Evolut delivery system and valve were removed as a unit over the wire.

POTENTIAL PITFALLS: Aortic, iliac, or femoral injury: Reliant balloon was placed in the distal aorta use in case of arterial rupture.

TAKE-HOME MESSAGES: The Evolut delivery system can buckle and accordion under tension in complex aortic anatomy. A technique of snaring from above and tension from below can mitigate the buckled area and allow removal of the damaged delivery system via the endovascular route.