Management and Outcomes of Transcatheter Aortic Valve Replacement Valve Embolization: A Single-Center Experience

Objective: Transcatheter aortic valve replacement (TAVR) valve embolization is a rare but potentially catastrophic complication resulting from loss of prosthesis-annular contact after deployment. Contemporary data describing embolization patterns, management strategies, and associated outcomes remain limited. This study evaluates the clinical presentation, treatment approaches, and short-term outcomes of TAVR valve embolization at a single center.

Methods: We retrospectively identified 13 patients who experienced valve embolization during or after TAVR (2014-2025). Baseline demographics, comorbidities, procedural characteristics, embolization timing and direction (cephalad vs caudad), management strategy, and clinical outcomes were collected.  

Results: The case series had a mean age of 81.6±5.1 years, 46.2% were female, and mean Society of Thoracic Surgeons predicted risk of mortality was 4.29±2.52. At baseline, 39% of patients were New York Heart Association class III-IV, with a preserved left ventricular ejection fraction of 62.7 ± 5.5%. Most patients had a virgin chest (84.6%), while one had a prior sternotomy and one had two prior sternotomies. Atrial fibrillation was present in 30.8% of patients. 12 procedures were performed using self-expanding valves (mean valve size 27.3±1.7 mm). Embolization occurred during deployment in one case and after final deployment in the remainder. Pre- and postdilation were performed in 33.3% and 58.2% of cases, respectively. Embolization was cephalad in 11 patients and caudad in 2. Management included surgical bailout with surgical aortic valve replacement in 6 patients, valve-in-valve (ViV) implantation in 3 patients (all annular or left ventricular outflow tract embolizations), and endovascular snaring in 4 patients. One patient required postprocedural intra-aortic balloon pump support. Median hospital length of stay was 4 days [IQR 2-14]. Thirty-day mortality was 23.1% (n = 3), with no perioperative strokes. Echocardiography demonstrated significant improvements in aortic valve area and mean transvalvular gradients post-intervention. One-year mortality was 46.2% (n = 6) overall and varied by management strategy. 

Conclusions: TAVR valve embolization remains associated with substantial mortality particularly in patients requiring surgical bailout. Management strategies should be tailored to embolization location and direction.